SHM Converge Scientific Abstract ePoster Gallery-WHY SO HOT? <br /><br />a CASE REPORT OF SEROTONIN SYNDROME IN a PATIENT WITH STIFF PERSON SYNDROME

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This case report describes a 44-year-old woman with stiff person syndrome, treated with baclofen, diazepam, and IVIG, and depression treated with duloxetine, who presented with altered mental status, severe hyperthermia, tachycardia, hypertension, and marked myoclonus. Her exam and medication history met Hunter criteria for serotonin syndrome, likely triggered by serotonergic exposure. However, the differential also included baclofen withdrawal, stiff person syndrome-related symptoms, sepsis, neuroleptic malignant syndrome, and malignant hypertension.<br /><br />Her workup showed elevated CK and lactate, normal thyroid studies, and a negative urine toxicology screen. She also had E. coli bacteremia and a urinary tract infection, which may have contributed to her clinical picture. Management included stopping duloxetine, continuing baclofen, giving IV lorazepam, hypothermic therapy, IV fluids, and empiric antibiotics.<br /><br />The report emphasizes that serotonin syndrome, baclofen withdrawal, and stiff person syndrome can present with similar features such as autonomic instability and neuromuscular hyperexcitability. Careful history, medication review, and physical examination are essential for diagnosis. Treatment focuses on removing the offending agent, supportive care, benzodiazepines, and close monitoring, with more aggressive interventions such as sedation, paralysis, and intubation needed in severe cases.

Asset Subtitle

Ya Zhou

Meta Tag

Author List Bogdan Tiru, Ya Zhou

Category Clinical Vignettes

Concept Serotonin Syndrome

Concept Hunter Criteria

Concept Serotonergic Activity

Concept Clinical Presentation

Concept Hyperthermia

Distinguished Non-Finalist

Presenter Organization Baystate Medical Center

Presenting Author Ya Zhou

Track Adult

Keywords

serotonin syndrome

stiff person syndrome

baclofen withdrawal

duloxetine

hyperthermia

myoclonus

autonomic instability

benzodiazepines

E. coli bacteremia

Hunter criteria

Serotonin Syndrome

Hunter Criteria

Serotonergic Activity

Clinical Presentation

Hyperthermia