A 52-year-old woman comes to the emergency department due to recurrent right lower extremity swelling, pain, and erythema. The patient's medical history includes type 2 diabetes mellitus and depression. Her medications include metformin, paroxetine, and a multivitamin. The patient is diagnosed with cellulitis, admitted to the hospital, and started on antibiotics. She is continued on her home medications. Three days later, the patient becomes agitated and delirious with severe abdominal cramps and diarrhea. Her temperature is 39.2 C (102.6 F), blood pressure is 180/100 mm Hg, and heart rate is 120/min and regular. On examination, the patient is diaphoretic and tremulous, and her pupils are dilated. Bilateral hyperreflexia and ankle clonus are present. She begins to have seizures. Which of the following antibiotics was the patient most likely given to treat the cellulitis?

Question

A 52-year-old woman comes to the emergency department due to recurrent right lower extremity swelling, pain, and erythema.  The patient's medical history includes type 2 diabetes mellitus and depression.  Her medications include metformin, paroxetine, and a multivitamin.  The patient is diagnosed with cellulitis, admitted to the hospital, and started on antibiotics.  She is continued on her home medications.  Three days later, the patient becomes agitated and delirious with severe abdominal cramps and diarrhea.  Her temperature is 39.2 C (102.6 F), blood pressure is 180/100 mm Hg, and heart rate is 120/min and regular.  On examination, the patient is diaphoretic and tremulous, and her pupils are dilated.  Bilateral hyperreflexia and ankle clonus are present.  She begins to have seizures.  Which of the following antibiotics was the patient most likely given to treat the cellulitis?

Quizplus · Accepted Answer

11ec160b_3c37_48dc_9249_71219c3a4bb5_MD0001_00 Serotonin syndrome is characterized by a triad of autonomic instability (eg, hyperthermia, hypertension, tachycardia), altered mental status (eg, agitation, confusion), and neuromuscular hyperactivity (eg, tremor, hyperreflexia, myoclonus), as well as gastrointestinal symptoms and diaphoresis. It is due to an increased serotonergic effect in the central nervous system (eg, increased 5-HT1A and 5-HT2A receptor stimulation). Serotonin syndrome rarely occurs with a single serotonergic drug used at therapeutic doses. More commonly, it is due to the combined effects of several serotonergic medications, overdose, and/or a drug-drug interaction. Serotonin effect is increased when a monoamine oxidase inhibitor (MAOI) is combined with a serotonergic antidepressant (selective serotonin reuptake inhibitor [SSRI], serotonin-norepinephrine reuptake inhibitor, or tricyclic antidepressant). Linezolid is used to treat infections caused by gram-positive bacteria, particularly vancomycin-resistant enterococcus and methicillin-resistant Staphylococcus aureus. Linezolid has MAOI activity and therefore can precipitate serotonin syndrome with concomitant use of an SSRI (eg, paroxetine) or with other serotonergic medications. (Choices A, B, D, and E) Clindamycin, doxycycline, penicillin, and vancomycin do not have MAOI effects. They do not cause serotonin syndrome when combined with a serotonergic antidepressant. Educational objective: Serotonin syndrome is characterized by a triad of autonomic instability, altered mental status, and neuromuscular irritability. It may develop when a monoamine oxidase inhibitor (MAOI) antidepressant or a non-antidepressant with MAOI activity (eg, linezolid) is combined with a serotonergic medication such as a selective serotonin reuptake inhibitor, serotonin-norepinephrine reuptake inhibitor, or tricyclic antidepressant. __________ References: Clinical relevance of linezolid-associated serotonin toxicity. (http://www.ncbi.nlm.nih.gov/pubmed/23424229) Serotonin syndrome due to co-administration of linezolid and methadone. (http://www.ncbi.nlm.nih.gov/pubmed/28956544)

A 52-Year-Old Woman Comes to the Emergency Department Due to Recurrent