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Serotonin syndrome from sertraline and linezolid — SCE Acute Medicine MCQ

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HardPsychiatry and clinical pharmacologySerotonin syndrome from sertraline and linezolidSCE Acute Medicine

A 33-year-old woman taking sertraline develops agitation, diarrhoea, sweating and tremor after starting linezolid for pneumonia. Temperature is 38.9°C, pulse 132/min and examination shows inducible clonus and hyperreflexia. CK is mildly raised. What is the most likely diagnosis?

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Correct answer: A — Serotonin syndrome

Serotonin syndrome is suggested by serotonergic drug interaction, rapid onset, autonomic instability, diarrhoea and neuromuscular hyperactivity with clonus. Neuroleptic malignant syndrome is usually slower and associated with lead-pipe rigidity and dopamine antagonist exposure. Management includes stopping serotonergic drugs, supportive care, benzodiazepines and specialist toxicology advice.

Reference: TOXBASE serotonin syndrome; BNF linezolid interactions