This article describes a case of Serotonin syndrome (SS), which developed in
a patient with treatment resistant schizophrenia post-hemi colectomy. Patient
was a 38-year-old, male with treatment resistant schizophrenia who
developed septic shock secondary to ischemic sigmoid volvulus, complicated
with nosocomial pneumonia and surgical site infection post-operation.
Antipsychotics (haloperidol and amisulpiride) was reinitiated a week postoperation
when his medical condition was stabilized as patient began to show
symptoms of psychosis. Haloperidol was later switched to olanzapine as he
was still agitated and disturbed. Fluvoxamine 50mg was added as he
displayed hair-pulling behavior. Clopixol accuphase and parental sedation
with midazolam and phenergen was given as adjunctive management for
agitation. Several days after, he became more restless. Central nervous
system examination revealed rigidity, tremors, hyperreflexia and clonus.
Discontinuation of fluvoxamine and amisulpiride with reduction of
olanzapine to 20mg ON resulted in full neurologic recovery within the first 24
hours. It was not well understood how this patient developed serotonin
syndrome despite him on low dose of fluvoxamine. Clinicians should be
aware of risk of serotonin syndrome when adding serotonergic agents to
antipsychotics especially in patients’ post-hemi colectomy.