Serotonin Syndrome Versus Neuroleptic Malignant Syndrome in a Pediatric Patient Receiving Fluoxetine and Haloperidol: A Case Report

The prevalence of mental disorders in children and adolescents has increased over the years, along with a rise in the prescription of psychotropic medications in this population. Evidence and drug safety studies in children, however, remain scarce, with many treatments being prescribed off-label. Serotonin syndrome and neuroleptic malignant syndrome are both potentially life-threatening conditions associated with the use of psychotropic medications, with symptoms frequently overlapping. This case report describes a mixed presentation of serotonin syndrome and neuroleptic malignant syndrome in a 12-year-old female patient receiving combined treatment with fluoxetine and haloperidol. She presented with intermittent generalized muscle rigidity and dystonia, tremors, muscle clonus, diaphoresis, and hyperreflexia. Blood analysis showed an elevated creatine phosphokinase plasma concentration. She required continuous cardiac monitoring and treatment with intravenous fluids and diazepam, with a complete resolution of symptoms. This case highlights the importance of awareness of the adverse effects of psychotropic treatments in the pediatric population.