Journal of medical case reports · 2025
Fatal outcome of severe serotonin syndrome and acute respiratory distress syndrome after self-poisoning with paroxetine: a case report.
СтатьяКлинический случайНазвание и аннотация: Перевод пока не подготовлен
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Pütz Sina M, Hüser Christoph, Onur Oezguer A, Steindl David, Eichenauer Dennis A, Naendrup Jan-Hendrik, Neumann Marie Anne-Catherine, Schmidt Nathalie M, Stein Alexander F Vom, Böll Boris
Аннотация
BACKGROUND: Paroxetine overdose can cause serotonin syndrome, presenting with a constellation of manifestations that range from mild symptoms to life-threatening complications. Current evidence regarding the management of paroxetine-induced serotonin syndrome is limited to case reports and small case series, with no definitive recommendations established from controlled clinical trials in humans.
CASE PRESENTATION: In this case report, we describe an exceptional and severe clinical course of a 26-year-old Caucasian female who ingested multiple drugs with suicidal intention-including 4000 mg paroxetine. The patient developed severe serotonin syndrome complicated by acute respiratory distress syndrome, necessitating invasive mechanical ventilation and veno-venous extracorporeal membrane oxygenation. Serotonin syndrome prevailed unusually long, with serum paroxetine levels remaining within the lethal dose range for 20 days postingestion. Despite intensive therapeutic interventions-including CytoSorb™ hemoadsorption, adjunctive corticosteroids, olanzapine (10 mg/day), and maximal intensive care treatment-the patient died on day 20 postingestion.
CONCLUSION: Our case illustrates the importance of early and aggressive intervention, while highlighting the limited efficacy of currently available extracorporeal elimination techniques in severe paroxetine overdose. Given the protracted and progressive symptoms observed in this case report and others, clinicians should remain vigilant for pharmacokinetic complications such as pharmacobezoars or poor CYP2D6 metabolism in massive selective serotonin reuptake inhibitor overdose, leading to an early and aggressive treatment in similar cases with serotonin syndrome.
CASE PRESENTATION: In this case report, we describe an exceptional and severe clinical course of a 26-year-old Caucasian female who ingested multiple drugs with suicidal intention-including 4000 mg paroxetine. The patient developed severe serotonin syndrome complicated by acute respiratory distress syndrome, necessitating invasive mechanical ventilation and veno-venous extracorporeal membrane oxygenation. Serotonin syndrome prevailed unusually long, with serum paroxetine levels remaining within the lethal dose range for 20 days postingestion. Despite intensive therapeutic interventions-including CytoSorb™ hemoadsorption, adjunctive corticosteroids, olanzapine (10 mg/day), and maximal intensive care treatment-the patient died on day 20 postingestion.
CONCLUSION: Our case illustrates the importance of early and aggressive intervention, while highlighting the limited efficacy of currently available extracorporeal elimination techniques in severe paroxetine overdose. Given the protracted and progressive symptoms observed in this case report and others, clinicians should remain vigilant for pharmacokinetic complications such as pharmacobezoars or poor CYP2D6 metabolism in massive selective serotonin reuptake inhibitor overdose, leading to an early and aggressive treatment in similar cases with serotonin syndrome.