Linezolid-Associated Serotonin Syndrome

2015 ◽  
Vol 105 (3) ◽  
pp. 244-248 ◽  
Author(s):  
Robert G. Frykberg ◽  
Scott Gordon ◽  
Edward Tierney ◽  
Jaminelli Banks
Keyword(s):  
Serotonin Syndrome ◽  
Monoamine Oxidase Inhibitor ◽  
Case Series ◽  
Oxidase Inhibitor ◽  
Serotonin Release ◽  
Diabetic Foot Infections ◽  
Complicated Skin ◽  
Antibiotic Drug ◽  
Threatening Condition ◽  
Life Threatening

Linezolid, a mild monoamine oxidase inhibitor, is a commonly used antibiotic drug for the treatment of complicated skin and skin structure infections, including diabetic foot infections. Use of linezolid has been associated with serotonin syndrome, a potentially life-threatening condition typically caused by the combination of two or more medications with serotonergic properties, due to increased serotonin release. The goals of this article are to highlight the risk factors associated with the development of serotonin syndrome related to the use of linezolid and to aid in its prevention and early diagnosis. In this case series we report on two hospitalized patients who, while being treated with linezolid for pedal infections, developed serotonin syndrome. Both individuals were also undergoing treatment with at least one serotonergic agent for depression and had received this medication within 2 weeks of starting the antibiotic drug therapy. In these individuals, we noted agitation, confusion, tremors, and tachycardia within a few days of initiation of linezolid therapy. Owing to the risk of serotonin toxicity, care should be taken when prescribing linezolid in conjunction with any other serotonergic agent. Although serotonin syndrome is an infrequent complication, it can be potentially life threatening. Therefore, risks and benefits of therapy should be weighed before use.

scholarly journals Serotonin Syndrome: Pathophysiology, Clinical Features, Management, and Potential Future Directions

2019 ◽  
Vol 12 ◽  
pp. 117864691987392 ◽  
Author(s):  
William J Scotton ◽  
Lisa J Hill ◽  
Adrian C Williams ◽  
Nicholas M Barnes
Keyword(s):  
Serotonin Syndrome ◽  
Tryptophan Hydroxylase ◽  
Monoamine Oxidase Inhibitor ◽  
Receptor Activation ◽  
Clinical Findings ◽  
Oxidase Inhibitor ◽  
Health Concern ◽  
Drug Induced ◽  
Life Threatening ◽  
Serotonergic Drugs

Serotonin syndrome (SS) (also referred to as serotonin toxicity) is a potentially life-threatening drug-induced toxidrome associated with increased serotonergic activity in both the peripheral (PNS) and central nervous systems (CNS). It is characterised by a dose-relevant spectrum of clinical findings related to the level of free serotonin (5-hydroxytryptamine [5-HT]), or 5-HT receptor activation (predominantly the 5-HT1A and 5-HT2A subtypes), which include neuromuscular abnormalities, autonomic hyperactivity, and mental state changes. Severe SS is only usually precipitated by the simultaneous initiation of 2 or more serotonergic drugs, but the syndrome can also occur after the initiation of a single serotonergic drug in a susceptible individual, the addition of a second or third agent to long-standing doses of a maintenance serotonergic drug, or after an overdose. The combination of a monoamine oxidase inhibitor (MAOI), in particular MAO-A inhibitors that preferentially inhibit the metabolism of 5-HT, with serotonergic drugs is especially dangerous, and may lead to the most severe form of the syndrome, and occasionally death. This review describes our current understanding of the pathophysiology, clinical presentation and management of SS, and summarises some of the drugs and interactions that may precipitate the condition. We also discuss the newer novel psychoactive substances (NPSs), a growing public health concern due to their increased availability and use, and their potential risk to evoke the syndrome. Finally, we discuss whether the inhibition of tryptophan hydroxylase (TPH), in particular the neuronal isoform (TPH2), may provide an opportunity to pharmacologically target central 5-HT synthesis, and so develop new treatments for severe, life-threatening SS.

scholarly journals Right ventricular thrombus, a challenge in imaging diagnostics: a case series

2021 ◽  
Author(s):  
Massimo Barbagallo ◽  
Daryl Naef ◽  
Pascal Köpfli ◽  
Urs Hufschmid ◽  
Tilo Niemann ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Case Series ◽  
General Medicine ◽  
High Sensitivity ◽  
Cost Effective ◽  
Ventricular Thrombus ◽  
Threatening Condition ◽  
Life Threatening ◽  
Therapeutic Decision Making ◽  
Sensitivity Specificity

Abstract Background Presence of right ventricular thrombus (RVT) is a rare but life-threatening condition, thus immediate diagnosis and therapy are mandatory. Unfortunately, detection and distinction from intraventricular tumor masses or vegetations represents a complex task. Furthermore, consecutive therapy is principally led by clinical presentation without considering morphological features of the thrombus. Current literature suggests a multimodal non-invasive imaging approach. In this paper, we discuss the role of cardiac magnetic resonance (CMR) for the detection of RVT in patients with pulmonary embolism (PE). We consider the relatively expensive and not broadly available imaging procedure and weigh it up to its assumed high sensitivity, specificity and importance for differential diagnosis and therapeutic decision making. Case Summary In this case series we report three cases of RVT with concomitant PE, whereof two were missed during routine cardiac workup by transthoracic echocardiography (TTE) and computer tomography (CT). CMR led to detection and further characterization of the thrombi in both cases. These patients were diagnosed and treated at the Cantonal Hospital of Baden in the division of General Medicine. Conclusions CMR reliably detects and characterizes RVT, even under unfavourable conditions for echocardiography such as arrhythmia, adiposity or in posterior position of RVT. Obtained information could facilitate the choice of therapeutic approach (anticoagulation vs. systemic lysis, vs. surgical thrombectomy). Future risk-stratification scores will promote cost-effective use of CMR.

scholarly journals Serotonin Syndrome in the Setting of Lamotrigine, Aripiprazole, and Cocaine Use

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Anupam Kotwal ◽  
Sarah L. Cutrona
Keyword(s):  
Cocaine Abuse ◽  
Serotonin Syndrome ◽  
Pharmacodynamic Interactions ◽  
Serotonergic Activity ◽  
Threatening Condition ◽  
Neuromuscular Abnormalities ◽  
Life Threatening ◽  
The Central Nervous System ◽  
Autonomic Hyperactivity ◽  
Toxicity Criteria

Serotonin syndrome is a potentially life-threatening condition associated with increased serotonergic activity in the central nervous system. It is classically associated with the simultaneous administration of two serotonergic agents, but it can occur after initiation of a single serotonergic drug or increasing the dose of a serotonergic drug in individuals who are particularly sensitive to serotonin. We describe a case of serotonin syndrome that occurred after ingestion of higher than prescribed doses of lamotrigine and aripiprazole, in addition to cocaine abuse. The diagnosis was established based on Hunter toxicity criteria and severity was classified as mild. The features of this syndrome resolved shortly after discontinuation of the offending agents. Serotonin syndrome is characterized by mental status changes, autonomic hyperactivity, and neuromuscular abnormalities along a spectrum ranging from mild to severe. Serotonin syndrome in our patient was most likely caused by the pharmacokinetic and pharmacodynamic interactions between lamotrigine, aripiprazole, and cocaine leading to increased CNS serotonergic activity.

Transesophageal Echocardiogram-Guided Stent Placement in Superior Vena Cava Syndrome Secondary to Granulomatous Lung Disease: A Case Series and Literature Review

2017 ◽  
Vol 51 (8) ◽  
pp. 562-566 ◽  
Author(s):  
Kaiwen Sun ◽  
Rishi Batra ◽  
Nicholas W. Markin ◽  
Melissa Suh ◽  
Iraklis I. Pipinos ◽  
...  
Keyword(s):  
Superior Vena Cava ◽  
Stent Placement ◽  
Superior Vena ◽  
Vena Cava ◽  
Case Series ◽  
Stent Migration ◽  
Respiratory Compromise ◽  
Svc Syndrome ◽  
Threatening Condition ◽  
Life Threatening

Obstruction of the superior vena cava (SVC) is an uncommon, but potentially life-threatening condition due to likely development of edema in the head and neck and potential respiratory compromise. Less than half of those affected by SVC syndrome survive more than a year. Obstruction can be from neoplasms or secondary to benign disease. Treatment for most cases of symptomatic SVC syndrome involves placement of a stent to relieve the stenosis. Serious complications such as stent migration, pulmonary embolism, and cardiac tamponade can occur in 5% to 10% of cases, and inadequate imaging of the SVC–atrial junction by fluoroscopy contributes to these problems. The overlapping contrast in the atrium makes it difficult to precisely place the distal end of the stent, potentially allowing for embolization of the stent to occur. We present a case series of 3 patients wherein transesophageal echocardiography was used for guidance of stent placement in the SVC and significantly aided in placement.

scholarly journals Perioperative adolescent serotonin syndrome secondary to methadone and fentanyl administration: A case report

2021 ◽  
Vol 2 (3) ◽  
Author(s):  
Emily Anne Smith Bergbower ◽  
◽  
Enoch Cheung ◽  
Caron Hong ◽  
◽  
...  
Keyword(s):  
Selective Serotonin Reuptake Inhibitor ◽  
Reuptake Inhibitor ◽  
Serotonin Reuptake ◽  
Serotonin Syndrome ◽  
Monoamine Oxidase Inhibitor ◽  
Opioid Analgesic ◽  
Oxidase Inhibitor ◽  
Selective Serotonin ◽  
Adolescent Male ◽  
Serotonin Reuptake Inhibitor

Serotonin Syndrome (SS) is a serious toxidrome associated with significant morbidity when undiagnosed or improperly managed. We report a perioperative case of serotonin syndrome in an adolescent male on fluoxetine (selective serotonin reuptake inhibitor-SSRI) therapy secondary to an intraoperative combined opioid analgesic regiment. He received low dose methadone and fentanyl for induction for a LeFort osteotomy, the presumed trigger for his perioperative SS. This study demonstrates the essential need for anesthesiologists’ vigilance regarding identifying SS, risk factors of SS and implementation of immediate and effective management. Abbreviations: GAD: Generalized Anxiety Disorder; GPCR: G-protein Coupled Receptor; IV: Intravenous; MAOI: Monoamine Oxidase Inhibitor; MDD: Major Depressive Disorder; OR: Operating Room; PACU: Post-Anesthesia Care Unit; RAE: Right Angle Endotracheal; SERT: Serotonin Transporter; SNRI: Serotonin-Norepinephrine Reuptake Inhibitor; SS: Serotonin Syndrome; SSRI: Selective Serotonin Reuptake Inhibitor.

CASE SERIES OF PREGNANCY-ASSOCIATED MYOCARDIAL INFARCTION: AN EPIDEMIC IN WAITING

2021 ◽  
pp. 28-30
Author(s):  
Shree Bharathi ◽  
Sasirekha Rengaraj
Keyword(s):  
Myocardial Infarction ◽  
Care Center ◽  
Tertiary Care ◽  
Case Series ◽  
Fetal Outcome ◽  
Therapeutic Implications ◽  
Threatening Condition ◽  
Life Threatening ◽  
Common Etiology ◽  
Artery Disease

Acute myocardial infarction during pregnancy or postpartum period is a rare but life-threatening condition associated with poor maternal and fetal outcome. Although atherosclerotic coronary artery disease is the most common etiology in general population, the causation is more diverse in pregnancy and this may have therapeutic implications. Early diagnosis and timely management with collaboration among Maternal-fetal medicine specialist, interventional cardiologist, cardiac anaesthetist, intensivist and neonatologist is essential to prevent maternal cardiac deaths. We present a case series of two patients with postpartum and antepartum acute MI, respectively and their diagnosis, management and outcomes in a tertiary care center.

Augmentation of phenelzine with aripiprazole and quetiapine in a treatment-resistant patient with psychotic unipolar depression: case report and literature review

CNS Spectrums ◽  
2016 ◽  
Vol 22 (5) ◽  
pp. 391-396 ◽  
Author(s):  
Jonathan M. Meyer ◽  
Michael A. Cummings ◽  
George Proctor
Keyword(s):  
Serotonin Syndrome ◽  
Monoamine Oxidase Inhibitor ◽  
Bipolar Depression ◽  
Unipolar Depression ◽  
Oxidase Inhibitor ◽  
Adverse Outcomes ◽  
Treatment Resistant ◽  
Significant Efficacy ◽  
History Of ◽  
Resistant Patient

Irreversible monoamine oxidase inhibitor (MAOI) antidepressants have significant efficacy in treatment-resistant unipolar depression, but in some instances patients may not achieve remission. Among the adjunctive and augmentation strategies, certain second-generation antipsychotics (SGAs) have approval for inadequate responders to antidepressant therapy, including aripiprazole, brexpiprazole, and quetiapine, with lurasidone and the olanzapine/fluoxetine combination indicated for bipolar depression. Clinicians may eschew SGA options in part due to the limited literature on SGA–MAOI combinations, with only one published case involving aripiprazole, and none for olanzapine, lurasidone, or brexpiprazole. In addition to the limited publication history on SGA–MAOI treatment, clinicians may also be deterred by uncertainty regarding SGA mechanisms and the risk of serotonin syndrome or other adverse outcomes. This paper describes the case of a 54-year-old male with a history of psychotic unipolar depression treated with a combination of phenelzine, aripiprazole, and quetiapine, and reviews the 12 published cases of SGA–MAOI combination therapy with a focus on the pharmacological basis for serotonin syndrome, and the SGA mechanisms that should not be associated with a risk for this syndrome.

scholarly journals Serotonin syndrome due to an overdose of moclobemide?

CJEM ◽  
2002 ◽  
Vol 4 (02) ◽  
pp. 98-101 ◽  
Author(s):  
Andrew Ip ◽  
Tia Renouf
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Serotonin Syndrome ◽  
Monoamine Oxidase Inhibitor ◽  
Altered Mental Status ◽  
Oxidase Inhibitor ◽  
Important Condition ◽  
Autonomic Instability ◽  
Neuromuscular Abnormalities

ABSTRACTSerotonin syndrome, a triad of autonomic instability, altered mental status and neuromuscular abnormalities, is usually attributed to serotonergic overdoses. Moclobemide is a new selective monoamine oxidase inhibitor (MAOI) that generally causes mild, self-limited gastrointestinal and central nervous system effects after ingestion. We present a case of serotonin syndrome that occurred after moclobemide overdose, and discuss the recognition and treatment of this important condition. Serotonin syndrome may become increasingly common because of the liberal use of selective serotonin reuptake inhibitors, new MAOIs and other agents such as codeine and meperidine, which have the potential for harmful interaction.

scholarly journals Management of Upper Airway Infantile Hemangiomas: Experience of One Italian Multidisciplinary Center

2021 ◽  
Vol 9 ◽  
Author(s):  
Marialuisa Corbeddu ◽  
Duino Meucci ◽  
Andrea Diociaiuti ◽  
Simona Giancristoforo ◽  
Roberta Rotunno ◽  
...  
Keyword(s):  
Case Series ◽  
Upper Airway ◽  
Duration Of Treatment ◽  
Cutaneous Lesions ◽  
Phaces Syndrome ◽  
Threatening Condition ◽  
Life Threatening ◽  
Line Of Therapy ◽  
Oral Propranolol

Airway infantile hemangiomas (IHs) can represent a life-threatening condition since the first months of life. They may be isolated or associated to cutaneous IHs, and/or part of PHACES syndrome. Diagnosis, staging, and indication to treatment are not standardized yet despite the presence in the literature of previous case series and reviews. The diagnosis might be misleading, especially in the absence of cutaneous lesions. Airway endoscopy is the gold standard both for diagnosis and follow-up since it allows evaluation of precise localization and entity of obstruction and/or stricture. Proliferation of IH in the infant airways manifests frequently with stridor and treatment is required as soon as possible to prevent further complications. The first line of therapy is oral propranolol, but duration of treatment is not yet well-defined. All considered, we report the experience of our multidisciplinary center from 2009 to date, on 36 patients affected by airway IHs, and successfully treated with oral propranolol. Thus, the authors propose their experience for the management of airway IHs, specifically early diagnosis, when to perform endoscopy, how to interpret its findings, and when to stop the treatment.

scholarly journals Different Manifestations of Rare Cases of Unruptured Sinus of Valsalva Aneurysm—Case Series and Literature Review

2018 ◽  
Vol 28 (03) ◽  
pp. 202-206 ◽  
Author(s):  
Bhagya Narayan Pandit ◽  
Siva Subramaniyan ◽  
Tarun Kumar ◽  
Richa Agrawal ◽  
Deepankar Vatsa
Keyword(s):  
Case Reports ◽  
Case Series ◽  
Individual Case ◽  
Sinus Of Valsalva ◽  
Aortic Sinus ◽  
Sinus Of Valsalva Aneurysm ◽  
Severe Aortic Regurgitation ◽  
First Case ◽  
Threatening Condition ◽  
Life Threatening

AbstractSinus of Valsalva aneurysm (SVA) is rare, and aneurysm of the left sinus of Valsalva is extremely rare cardiovascular disease. Clinical presentation can vary from mostly asymptomatic to catastrophic life-threatening emergency. We report four extremely rare cases of SVA with different manifestations of which one case involved left aortic sinus with large unruptured aneurysm causing severe mitral regurgitation (MR) and severe aortic regurgitation (AR). The second case aneurysm was from right sinus presented with trifascicular block with intermittent complete heart block (CHB). Third was a diagnosed case of unruptured right SVA and while awaiting for surgery he had sudden cardiac death (SCD) at home. Therefore, SVA can present from asymptomatic to life-threatening condition, such as SCD. To the best of our knowledge, there are individual case reports in literature, and this is the first case series of unruptured SVA in literature highlighting the rarity of this disease.

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