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Serotonin syndrome — ABIM Board MCQ

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HardPsychiatry relevant to Internal MedicineSerotonin syndromeABIM Board

A 42-year-old taking sertraline develops agitation, diaphoresis, diarrhea, hyperreflexia, and inducible clonus 36 hours after linezolid is started. Temperature is 39.3 C; there is no lead-pipe rigidity. The interacting drugs are stopped. Which additional management is most appropriate?

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Correct answer: D — Give benzodiazepines and supportive care with cyproheptadine for persistent toxicity

The best answer is “Give benzodiazepines and supportive care with cyproheptadine for persistent toxicity”. Clonus and hyperreflexia after an SSRI–linezolid interaction identify serotonin toxicity. Removing serotonergic agents, supportive care, cooling, and benzodiazepines are central; cyproheptadine is reasonable when clinically significant symptoms persist. Bromocriptine and dantrolene address different toxidromes, physostigmine can be dangerous here, and re-exposure perpetuates serotonin excess.

Reference: Management of Serotonin Syndrome (Toxicity): https://pmc.ncbi.nlm.nih.gov/articles/PMC11862804/