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A 52-year-old male taking sertraline 200 mg daily is prescribed tramadol by his primary care provider for acute back pain. He presents to the emergency department 8 hours later with agitation, diaphoresis, diarrhea, hyperthermia of 39.2C, bilateral lower extremity clonus, and hyperreflexia. Which of the following diagnoses is most consistent with this clinical presentation?
Explanation
Recognizing serotonin syndrome requires two skills: identifying the serotonergic combination (including commonly overlooked triggers such as tramadol, linezolid, and dextromethorphan) and recognizing clonus as the distinguishing physical finding. Clonus points to serotonin syndrome; rigidity points to NMS. This distinction is the key clinical differentiator.
Key Takeaway
Clonus is the hallmark finding that distinguishes serotonin syndrome from NMS; tramadol is a commonly tested hidden serotonergic agent.