急性橫斷性脊髓炎病患合併血清素症候群：病例報告

Serotonin Syndrome in Acute Transverse Myelitis: A Case Report

謝佩君(Pei-Chun Hsieh) ； 陳若佟(Jo-Tong Chen) ； 官大紳(Ta-Shen Kuan) ； 程琡敏(Shu-Min Chen)

《台灣復健醫學雜誌》 39卷1期 (2011/03) Pp. 58-68

https://doi.org/10.6315/2011.39(1)09

摘要

近年來有相當多的藥物藉由增加體內血清素活性來治療包括憂鬱、疼痛、失眠、肥胖等病症，且其臨床使用有愈來愈普遍之趨勢，然而合併使用兩種或多種這類型藥物卻有可能會造成血清素症候群(serotonin syndrome)。其特徵主要有三：神經肌肉失常(neuromuscular abnormalities)、自主神經過度興奮(autonomic hyperactivity)與精神狀態改變(mental-status changes)。臨床症狀表現範圍很大，由輕微個案的震顫(tremor)與腹瀉至肌肉僵直(rigidity)或陣攣(clonus)、反射過強(hyperreflexia)、高燒，甚至散發性血管內凝血及器官衰竭均可能出現。血清素症候群之診斷仰賴臨床表現，藥物使用史以及停藥後症狀是否解除。本文報告一位二十七歲的女性病人，診斷爲急性橫斷性脊髓炎(acute transverse myelitis)致第四胸髓以下癱瘓(T4 flaccid paraplegia)及下運動神經元神經性膀胱(lower-motor-neuron type neurogenic bladder)。病患因情緒抑鬱及肢體麻痛而併用fluoxetine及tramadol，之後開始出現肌肉陣攣、盜汗、寒顫發抖及反覆高燒。在排除了其他可能因素，臨床懷疑爲併用fluoxetine和tramadol產生了血清素症候群。停藥後病患上述症狀很快即得到緩解，且後續追蹤近一年病患未曾再發生類似的症狀。血清素症候群診斷不易，本文報告此病患的臨床表現，並針對血清素症候群的相關文獻作回顧與討論。

關鍵字

急性橫斷性脊髓 ； 多發性硬化症 ； 血清素症候群

並列摘要

Numerous serotonergic drugs have been increasingly used in recent years to treat depression, pain, insomnia and obesity. However, concomitant use of these drugs may cause serotonin syndrome. The three main clinical features of serotonin syndrome are neuromuscular abnormalities, autonomic hyperactivity, and mental status changes. A wide variety of the clinical presentations range from: very mild symptoms such as tremor, diarrhea, muscle rigidity, or clonus, and hyperreflexia; to fatal consequences such as disseminated intravascular coagulation or multiple-organ failure. Symptoms resolve spontaneously after prompt discontinuation of the precipitating medication. The diagnosis is based on clinical presentation, history of medication, and resolution after discontinuing the causative agents.
We reported a 27-year-old female patient with acute transverse myelitis, suspected to be the first episode of multiple sclerosis, complicated with T4 flaccid paraplegia, and lower motor neuron type neurogenic bladder. The patient began to develop clonus, diaphoresis, shivering, and fever episodes after fluoxetine and tramadol were administered for depression and neuropathic pain. The patient’s symptoms resolved rapidly after discontinuation of the above medications. No similar symptoms were found in the following year. This paper describes the clinical features of serotonin syndrome and reviewed related literature.

並列關鍵字

acute transverse myelitis ； multiple sclerosis ； serotonin syndrome