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Differentiating between the two diseases is essential as management options greatly diverge. Since then, it has been described in the medical literature by a litany of names, among them pernicious catatonia, lethal catatonia, and acute fulminating psychosis . The patient initially presented to the hospital for abnormal behavior, hallucinations, and delusions. He had become increasingly withdrawn over the past few months and began to experience auditory and visual hallucinations several days prior to admission. The patient denied any chills or rigors. He recently completed a full course of amoxicillin and clarithromycin for pharyngitis, but these provided minimal alleviation of his complaints.
He was not on any other regular medications at home. The patient was a nonsmoker and had not ingested any alcohol in recent months. On examination, the patient was noted to be markedly diaphoretic, with flushing over his cheeks. Hg, heart rate 124 beats per minute, and temperature 37. He appeared tremulous and was stiff in his movements. He responded to questions with single-word answers and was resistant to most commands. He refused to open his mouth for examination.
Laboratory investigations revealed leukocytosis of 13. Throat, urine, and blood cultures were negative. Extended electrolytes, glucose, and renal and liver function results returned within normal limits. L, and urine drug screen detected only the presence of cannabinoids and benzodiazepines. Electroencephalography was normal and no unusual findings were noted on echocardiography. Because a diagnosis of serotonin syndrome was considered, the patient’s sertraline and quetiapine were subsequently discontinued. He was also prophylactically started on meropenem, but the antibiotic was stopped when all cultures returned negative.