PEBC MCQ Neurology & Mental Health question: linezolid in hospital for an infection

PEBC MCQNeurology & Mental Health

TC, 52, on sertraline 150 mg daily, was given linezolid in hospital for an infection. Within a day he became agitated, sweaty and tremulous, with a temperature of 38.6 °C and inducible clonus. Which of the following is the most likely diagnosis?

a. Serotonin syndrome
b. Neuroleptic malignant syndrome
c. Alcohol withdrawal
d. Anticholinergic toxicity

Show the answer and explanation

Answer: a. Serotonin syndrome

Linezolid is a reversible MAO inhibitor, and combined with an SSRI it can cause serotonin syndrome: rapid onset of agitation, diaphoresis, tremor, hyperthermia and neuromuscular hyperactivity such as clonus and hyperreflexia (Hunter criteria). Neuroleptic malignant syndrome develops more slowly with lead-pipe rigidity after dopamine antagonists, and anticholinergic toxicity causes dry, hot skin rather than sweating. Source: Linezolid (Zyvoxam) product monograph, Warnings: serotonin syndrome (DPD, checked 2026); Health Canada advisory on serotonergic drugs and linezolid (2011).

Common mistake

Missing linezolid as a serotonergic interacting drug.

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