Sertraline and quetiapine induced Serotonin Syndrome and Neuroleptic Malignant Syndrome: a case report

Serotonin Syndrome (SS) and Neuroleptic Malignant Syndrome (NMS) are more likely to occur in psychiatric patients. Both conditions have a low incidence rate but can be life-threatening in severe cases.they are easily overlooked, misdiagnosed, or missed in clinical practice. A case of a girl who ingested 700 mg of sertraline,350 mg of quetiapine and 90 mg of oxazepam, presenting with altered consciousness, hallucinations, muscle rigidity, and rhabdomyolysis. Laboratory results showed a creatine phosphokinase (CPK) concentration of 20,930 U/L, lactate dehydrogenase (LDH) of 593 U/L, and white blood cell (WBC) count of 15.1 × 10^9/L. The patient met the diagnostic criteria for both Serotonin Syndrome and Neuroleptic Malignant Syndrome, possibly exhibiting both adverse drug reactions closely spaced. Treatment involved discontinuing the implicated drugs, providing tracheal intubation, ventilatory support, continuous renal replacement therapy (CRRT), cardiac protection, anti-inflammatory treatment, norepinephrine to maintain blood pressure, and other treatments to support organ function. The patient recovered after one month. This article analyzes the clinical data and reviews the literature to discuss the management of severe complications caused by antipsychotic drugs and antidepressant drugs, aimed to improve awareness of these two adverse reactions. Guardians should strictly monitor the patient’s medication usage to prevent the child from freely accessing medications, thereby avoiding self-medication or overdose.