诊断学理论与实践

诊断学理论与实践 ›› 2023, Vol. 22 ›› Issue (03): 303-305.doi: 10.16150/j.1671-2870.2023.03.15

• 病例报告 • 上一篇    下一篇

抗帕金森病药物诱发5-羟色胺综合征1例

武冬冬1, 李淑华1, 苏闻1(), 刘银红1, 陈海波1, 陈頔2()   

  1. 1.北京医院神经内科 国家老年医学中心 中国医学科学院老年医学研究院，北京 100730
    2.北京医院药学部 国家老年医学中心 中国医学科学院老年医学研究院 北京市药物临床风险与个体化应用评价重点实验室（北京医院）,北京 100730
  • 收稿日期:2021-08-02 出版日期:2023-06-25 发布日期:2023-11-17
  • 通讯作者: 苏闻 E-mail: suwendy@126.com; 陈頔 E-mail: chendiaaa111@163.com
  • 基金资助:
    中央高水平医院临床科研业务费资助(BJ-2021-230)

Serotonin syndrome induced by anti-parkinsonism drugs：a case report

WU Dongdong1, LI Shuhua1, SU Wen1(), LIU Yinghong1, CHEN Haibo1, CHEN Di2()   

  1. 1. Department of Neurology, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
    2. Department of Pharmacy, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Beijing Key Laboratory of Assessment of Clinical Drugs Risk and Individual Application（Beijing Hospital）, Beijing 100730, China
  • Received:2021-08-02 Online:2023-06-25 Published:2023-11-17

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摘要：

5-羟色胺综合征是一种用药产生的药物不良反应，其主要特征是神经肌肉的过度兴奋，大多数情况下该病症状轻微，但在某些情况下可能会严重危及生命。本文报道1例87岁帕金森病（Parkinson’s disease, PD）患者起初因肺部感染、发热入院，经相应治疗后临床症状改善，但随后病情又波动，出现高热、大汗、意识障碍、肌张力高、肌酸激酶升高。医生结合上述临床表现，逐条分析抗PD药物种类剂量以及合并抗感染用药史后，发现患者超剂量服用司来吉兰，并与加用的抗感染药物利奈唑胺发生药物不良反应，及时诊断5-羟色胺综合征，并进行积极妥善处理，停用相关药物，结合物理降温、大量补液等对症支持治疗，使患者病情在24 h内得到有效控制，发病3 d后患者症状基本好转，发病5 d后其症状完全缓解。5-羟色胺综合征重在预防，临床医生应加强对此病的认识。

关键词: 5-羟色胺综合征, 帕金森病, 单胺氧化酶抑制剂, 利奈唑胺

Abstract:

Serotonin syndrome (SS) is an adverse drug reaction characterized by neuromuscular hyperexcitability that is mild in most cases but can be life-threatening in some cases. This paper reports a case of a 87-year-old man with Parkinson’s disease who was hospitalized due to pulmonary infection and fever. The clinical symptoms were improved after treatment. Subsequently, his condition fluctuated, including high fever, sweating, disturbance of consciousness, high muscle tone and elevated creatine kinase. After combining his clinical manifestations with his history of concomitant medication, the doctors found that the patient had overdosed on selegiline and had an adverse reaction with anti-infective drug linezolid. The patients was diagnosed having SS promptly and was treated actively and properly, including discontinuation of related medications, and physical cooling, extensive fluid rehydration, and symptomatic supportive treatment. Thus the patient’s condition was effectively controlled within 24 hours. The symptoms were basically improved 3 days after onset and completely relieved 5 days after onset. Prevention is the key point to SS, and clinicians should strengthen their awareness.

Key words: Serotonin syndrome, Parkinson’s disease, Monoamine oxidase inhibitor, Linezolid

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