A Case study of polypharmacy-induced serotonin syndrome in a cancer patient.
Andrew Zhu, Nicole Kuhnly, Leon Chen and 1 others
PMID 39051987WHAT IT FOUND
A cancer patient on dapsone, paroxetine, bupropion and methylene blue developed acute confusion, tachycardia and fever within an hour of methylene blue, despite improving oxygen.
Her mental status returned to normal over several hours after treatment.
Key findings
01A 54-year-old woman with lymphoma, on dapsone, paroxetine and bupropion, developed acute encephalopathy, tachycardia and fever within an hour of methylene blue, while her oxygen saturation improved.
02The clinical teams suspected early serotonin syndrome because symptoms started after methylene blue while she was taking paroxetine and bupropion, even though clonus and rigidity were absent.
03Her mental status returned to normal over several hours after antidepressants were stopped, lorazepam, acetaminophen and IV fluids were given, and she went home two days later.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is a case report, so it cannot show how often this happens or prove that methylene blue caused serotonin syndrome. The patient received dapsone, paroxetine, bupropion, methylene blue, lorazepam, acetaminophen and IV fluids around the time of onset and recovery, so the contribution of any single component cannot be separated. The suspected serotonin syndrome was not confirmed by a specific test, and classic signs such as clonus and rigidity were absent. The long discussion contains general background about methemoglobinemia and serotonin syndrome, not results from this patient.
The easy way to misread this
Do not conclude that methylene blue caused serotonin syndrome in this patient or that stopping antidepressants alone reversed her confusion. She received several medications and treatments around the same time, and this is a case report, not a controlled study.