Ashley Lipscomb, MD
University of Kentucky
Lexington, United States
Disclosure information not submitted.
Brad Withers, MD
Critical Care Anesthesiology Fellow
University of Kentucky, United States
Disclosure information not submitted.
David Bacon, MD
Assistant Professor
University of Kentucky College of Medicine
Lexington, Kentucky, United States
Disclosure information not submitted.
Katherin Sproul, MD
Assistant Professor
University of Kentucky, United States
Disclosure information not submitted.
Title: Severe Aortic Vasospasm in Serotonin Syndrome
Case Report Body:
Introduction: Clinical signs of Serotonin syndrome include cognitive changes, neuromuscular excitation, and autonomic instability, driven by the action of serotonin on 5HT1 and 5HT2 receptors. Though the action of serotonin on 5HT1 receptors can also induce arterial vasoconstriction, this is not commonly seen in serotonin syndrome. Instead, this is a feature of other syndromes associated with pathological serotonin release, such as Carcinoid syndrome. We present a case of severe aortic vasospasm in a patient with serotonin syndrome following cardiac surgery.
Description: A 55 year old female with a history of rheumatic heart disease, severe mitral and tricuspid valve regurgitation, atrial flutter, COPD, and depression on amitriptyline and duloxetine, presented for surgical valve repair. Postoperatively, the patient was admitted to the intensive care unit with hypotension, requiring epinephrine and dopamine. Her clinical status progressively deteriorated, and a methylene blue infusion was initiated for the treatment of vasoplegia. Soon after, she became acutely agitated and delirious with spontaneous ocular clonus, hyperreflexia, myoclonus, and muscle rigidity, consistent with serotonin syndrome. Methylene blue infusion was discontinued and intravenous lorazepam administered to no effect. In the subsequent hours, pressor requirements decreased, however she became febrile with severe lactic acidosis and multisystem organ failure. CT imaging demonstrated severe vasospasm of the proximal aorta and all major branches with ischemia of multiple organs.
Discussion: Serotonin can potentiate vasoconstriction of major arteries, including the aorta. Reports thus far of serotonin associated vasospasm perpetuate carcinoid syndrome as the inciting etiology. As both pathologies are intimately associated, the plausibility of similar pathogenesis between the two is extremely likely. We describe the first case of serotonin associated aortic vasospasm.