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Fever in a patient with osteomyelitis: the diagnosis could be serotonin syndrome

Awareness of rare differential diagnoses of common clinical presentations helps promote early detection and prompt management of serious conditions. A 54-year-old man, with an infected non-union following a high tibial osteotomy, presented with an acutely discharging abscess to his proximal tibia. H...

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Autores principales: Gould, Matthew, Harrison, William D, Cahill-Kearns, Abbey, Barton, Greg
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7871263/
https://www.ncbi.nlm.nih.gov/pubmed/33547128
http://dx.doi.org/10.1136/bcr-2020-239152
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author Gould, Matthew
Harrison, William D
Cahill-Kearns, Abbey
Barton, Greg
author_facet Gould, Matthew
Harrison, William D
Cahill-Kearns, Abbey
Barton, Greg
author_sort Gould, Matthew
collection PubMed
description Awareness of rare differential diagnoses of common clinical presentations helps promote early detection and prompt management of serious conditions. A 54-year-old man, with an infected non-union following a high tibial osteotomy, presented with an acutely discharging abscess to his proximal tibia. He was generally unwell with a Staphylococcus aureus bacteraemia. The tibia was debrided, CERAMENT G used as dead space management and a spanning external fixator applied. Postoperatively, pregabalin and tapentadol were commenced in addition to amitriptyline and sertraline, which the patient was taking regularly. Overnight, the patient developed hyperthermia, inducible clonus, hyperreflexia, agitation, confusion and rigors. Prompt recognition of the possibility of serotonin syndrome resulted in early cessation of serotonergic medications and a positive outcome. From this case an important message is that fever in a patient taking serotonergic medications should prompt a screening neurological examination. Clinicians should also be wary when patients are commenced on multimodal analgesia, including tapentadol.
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spelling pubmed-78712632021-02-18 Fever in a patient with osteomyelitis: the diagnosis could be serotonin syndrome Gould, Matthew Harrison, William D Cahill-Kearns, Abbey Barton, Greg BMJ Case Rep Case Report Awareness of rare differential diagnoses of common clinical presentations helps promote early detection and prompt management of serious conditions. A 54-year-old man, with an infected non-union following a high tibial osteotomy, presented with an acutely discharging abscess to his proximal tibia. He was generally unwell with a Staphylococcus aureus bacteraemia. The tibia was debrided, CERAMENT G used as dead space management and a spanning external fixator applied. Postoperatively, pregabalin and tapentadol were commenced in addition to amitriptyline and sertraline, which the patient was taking regularly. Overnight, the patient developed hyperthermia, inducible clonus, hyperreflexia, agitation, confusion and rigors. Prompt recognition of the possibility of serotonin syndrome resulted in early cessation of serotonergic medications and a positive outcome. From this case an important message is that fever in a patient taking serotonergic medications should prompt a screening neurological examination. Clinicians should also be wary when patients are commenced on multimodal analgesia, including tapentadol. BMJ Publishing Group 2021-02-05 /pmc/articles/PMC7871263/ /pubmed/33547128 http://dx.doi.org/10.1136/bcr-2020-239152 Text en © BMJ Publishing Group Limited 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Case Report
Gould, Matthew
Harrison, William D
Cahill-Kearns, Abbey
Barton, Greg
Fever in a patient with osteomyelitis: the diagnosis could be serotonin syndrome
title Fever in a patient with osteomyelitis: the diagnosis could be serotonin syndrome
title_full Fever in a patient with osteomyelitis: the diagnosis could be serotonin syndrome
title_fullStr Fever in a patient with osteomyelitis: the diagnosis could be serotonin syndrome
title_full_unstemmed Fever in a patient with osteomyelitis: the diagnosis could be serotonin syndrome
title_short Fever in a patient with osteomyelitis: the diagnosis could be serotonin syndrome
title_sort fever in a patient with osteomyelitis: the diagnosis could be serotonin syndrome
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7871263/
https://www.ncbi.nlm.nih.gov/pubmed/33547128
http://dx.doi.org/10.1136/bcr-2020-239152
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