Rare case of serotonin syndrome with therapeutic doses of paroxetine

Paroxetine (Paxil) is a selective serotonin reuptake inhibitor (SSRI) and anxiolytic that is approved to treat numerous mood disorders. Serotonin syndrome, defined as a triad of mental status changes, autonomic instability, and neuromuscular abnormalities, is a potentially life-threatening complication of administering such serotonin-modifying drugs. Most cases of serotonin syndrome that have occurred with paroxetine administration are due to inadvertent drug interactions, most notably between SSRIs and monamine oxidase inhibitors, or intentional overdoses. The authors present the case of an 80-year-old woman who presented with serotonin syndrome while on a therapeutic dose of paroxetine. Paroxetine was stopped, and aggressive hydration with fluids and treatment with cyproheptadine was followed by remarkable improvement and return to baseline status in 4 days. This case illustrates the importance for physicians to have a heightened sense of suspicion of the serotonin syndrome in any patient known to be on serotonin-modifying agents presenting with altered sensorium and cholinergic symptoms. Consequently, they will be able to start timely treatment without subjecting the patient to unnecessary and potentially harmful tests.

Rare Case of Rhabdomyolysis with Therapeutic Doses of Phendimetrazine Tartrate

Phendimetrazine tartrate is a newer drug that acts as a central stimulant and indirectly acting sympathomimetic with a host of uses similar to the class amphetamines. Its main use is as an anorectic in the short-term treatment of obesity, although stimulants are no longer indicated for this purpose. This drug appeals to the younger American population for immediate weight loss through decreased appetite and early satiety. The European Union markets have already withdrawn this medication as well as other countries, but phendimetrazine is still used within the United States. Rhabdomyolysis is a potentially life-threatening complication reported with higher doses of amphetamines. We present a case of rhabdomyolysis and myoglobinuria developing in a 23-year-old patient after oral administration of phendimetrazine tartrate for 3 days in suggested therapeutic doses. The medication was taken for short-term treatment of obesity, and patient did not have any predisposing factors to precipitate rhabdomyolysis. Rhabdomyolysis resolved within 5 days. To our knowledge, this is the first reported case of rhabdomyolysis from administration of therapeutic amounts of phendimetrazine tartrate. The purpose of this case report is to create an awareness among physicians about the potentially life-threatening complications associated with phendimetrazine use as an anorectic even in suggested therapeutic doses as was the case in our patient. Additional awareness is needed to educate their patients about the side effects associated with these drugs and to strongly discourage their unsupervised use.

Quadriplegia complicating ossification of the posterior longitudinal ligament

We report a case of quadriplegia complicating ossification of posterior longitudinal ligament (OPLL) in a patient who was also found to have diffuse idiopathic skeletal hyperostosis (DISH). She also had osteomalacia (Vit. D deficiency) with secondary hyperparathyroidism. There could be a cause and effect relationship between the abnormal biochemistry and OPLL.

Angiosarcoma of the heart presenting as recurrent cardiac tamponade

We present an interesting case of angiosarcoma of the heart presenting as recurrent percardial effusion and cardiac tamponade.