A 50 year old man presents to your emergency room in an agitated delirium. He appears anxious, restless, and disoriented. His chief complaint is vomiting and diarrhea. On examination, he is visibly sweating, his pulse is 100, his blood pressure is 140/90, and he has a fever. You notice he has a tremor in his extremities. He has rigidity of the lower extremities. On the neurologic exam, he has hyperreflexia and a bilateral Babinski sign.
You find out that he was at the hospital recently when he was diagnosed with and treated for depression. You ask him about this, and he says, "Oh yes, I read online that St. John's wort is really good for depression."
Challenge: What's the diagnosis?
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3 comments:
Serotonin syndrome from the interactions between the St. John's wort and (presumably) prescribed anti-depressant medications from previous hospital stay
some cytochrome issue + seratonin syndrome (?)
Complementary and Alternative Medicine
This is serotonin syndrome, which can be diagnosed from the clinical picture and history. The diagnosis of depression suggests that he may have been treated with a selective serotonin reuptake inhibitor (SSRI). St. John’s wort (Hypericum performatum) may also modulate serotonin levels and is associated with serotonin syndrome.
Source: UpToDate.
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