https://doi.org/10.4081/ecj.2024.12574

Neurotoxicity and PRES after severe citalopram intoxication in a 12-months-old baby

Early Access
Submitted: 15 April 2024
Accepted: 9 August 2024
Published: 2 September 2024
Citalopram intoxication, serotonin syndrome, posterior reversible encephalopathy syndrome, cyproheptadine
Abstract Views: 1998
PDF: 262
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

Sara Minghetti
sara.minghetti@irccs-sangerardo.it
https://orcid.org/0000-0002-8167-6007
Pediatric Neurology and Psychiatry Department, Fondazione IRCCS San Gerardo dei Tintori Monza, Italy.
Alessandra Lazzerotti
Pediatric Department, Fondazione MBBM, Fondazione IRCCS San Gerardo dei Tintori Monza, Italy.
Debora Sala
Pediatric Department, Fondazione MBBM, Fondazione IRCCS San Gerardo dei Tintori Monza, Italy.
Chiara Vimercati
https://orcid.org/0009-0000-2406-9254
Pediatric Department, Fondazione MBBM, Fondazione IRCCS San Gerardo dei Tintori Monza, Italy.
Sofia Giudici
https://orcid.org/0009-0004-9023-259X
Pediatric Department, Fondazione MBBM, Fondazione IRCCS San Gerardo dei Tintori Monza; School of Medicine and Surgery, Milano Bicocca University, Italy.
Santa Florio
Neuroimaging Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
Francesca Formica
https://orcid.org/0000-0002-4423-8200
Neuropsychiatry and Neurorehabilitation Unit, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy.
Stefania Zambrano
https://orcid.org/0000-0001-8338-4019
Clinical Neurophysiology Unit, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy.
Nivedita Agarwal
https://orcid.org/0000-0002-1387-9566
Neuroimaging Unit, Scientific Institute IRCCS E. Medea, Bosisio Parini, Lecco, Italy.
Cinzia Peruzzi
Pediatric Neurology and Psychiatry Department, Fondazione IRCCS San Gerardo dei Tintori Monza, Italy, Italy.

Citalopram intoxications can lead to Serotonin Syndrome (SS) development, characterized by altered mental status, seizures, autonomic instability, hyperthermia and extrapyramidal signs. We review the literature about pediatric acute citalopram intoxications, and we report a case of severe SS in an infant associated to Posterior Reversible Encephalopathy Syndrome (PRES) treated with cyproheptadine as an antidote. An adequate12-month-old girl displayed a sudden global neurological regression with hypotonia, prolonged occipital seizures, right hemiparesis and a progressive wakefulness reduction associated with blindness. Plasmatic concentration of citalopram was equal to 3225 ng/mL (50-110 ng/mL). MRI revealed a transient bilateral caudate and putamen hyperintensity, associated to an occipital cortical and subcortical hyperintensity. She was treated with IV cyproheptadine with progressive benefit in few days. Only 4 children with citalopram intoxication are previously described with neurological involvement. Pediatric citalopram intoxication could cause SS leading to PRES, and cyproheptadine could be used with benefit.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

Crossref
Scopus
Google Scholar
Europe PMC
Javad Alaghband-Rad MH. A randomized controlled clinical trial of citalopram versus fluoxetine in children and adolescents with obsessive-compulsive disorder (OCD). Eur Child Adolesc Psychiatry 2009;183:131–5. DOI: https://doi.org/10.1007/s00787-007-0634-z
Cipriani A, Zhou X, Del Giovane C, et al. Comparative efficacy and tolerability of antidepressants for major depressive disorder in children and adolescents: a network meta-analysis. Lancet 2016;388:881-90. DOI: https://doi.org/10.1016/S0140-6736(16)30385-3
Bezchlibnyk-Butler K, Aleksic I, Kennedy SH. Citalopram - A review of pharmacological and clinical effects. J Psychiatry Neurosci 2000;25:241–54.
Personne M, Sjöberg G, Persson H. Citalopram overdose - Review of cases treated in swedish hospitals. J Toxicol - Clin Toxicol 1997;35:237–40. DOI: https://doi.org/10.3109/15563659709001206
Klein-Schwartz W, Benson BE, Lee SC, Litovitz T. Comparison of citalopram and other selective serotonin reuptake inhibitor ingestions in children. Clin Toxicol 2012;50:418–23. DOI: https://doi.org/10.3109/15563650.2012.678497
Ducros A, Boukobza M, Porcher R, et al. The clinical and radiological spectrum of reversible cerebral vasoconstriction syndrome. A prospective series of 67 patients. Brain 2007;130:3091–101. DOI: https://doi.org/10.1093/brain/awm256
Prakash S, Rathore C, Kaushikkumar R. Posterior reversible encephalopathy syndrome in a patient with serotonin syndrome. BMJ Case Rep 2020;13:e236450. DOI: https://doi.org/10.1136/bcr-2020-236450
Bhutada AS, Kodankandath TV. Delayed presentation of posterior reversible encephalopathy syndrome in the setting of serotonin-norepinephrine reuptake inhibitors. Cureus 2022;14:e22454. DOI: https://doi.org/10.7759/cureus.22454
Malik MT, Majeed MF, Zand R. Serotonin syndrome presenting as a posterior reversible encephalopathy syndrome. Case Rep Neurol 2020;12:63–8. DOI: https://doi.org/10.1159/000505907
Tormoehlen LM, Rusyniak DE. Neuroleptic malignant syndrome and serotonin syndrome. 1st ed. Vol. 157, Handbook of Clinical Neurology. Elsevier B.V.; 2018. 663–675 p. DOI: https://doi.org/10.1016/B978-0-444-64074-1.00039-2
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ 2021;372:n71. DOI: https://doi.org/10.1136/bmj.n71
Rethlefsen ML, Kirtley S, Waffenschmidt S, et al. PRISMA-S: an extension to the PRISMA Statement for Reporting Literature Searches in Systematic Reviews. Syst Rev 2021;10:39. DOI: https://doi.org/10.1186/s13643-020-01542-z
Masullo L, Miller M, Baker SD, et al. Clinical course and toxicokinetic data following isolated citalopram overdose in an infant. Clin Toxicol 2006;44:165–8. DOI: https://doi.org/10.1080/15563650500514525
Janson JA, Wasylewicz ATM, Eijkemans M, et al. Citalopram intoxication in four week old infant. BMC Pediatr 2020;20:1–5. DOI: https://doi.org/10.1186/s12887-020-02439-5
Weigl J, Vloet T, Egberts K, et al. Non-fatal intoxication with a high dose of citalopram in a suicidal 14-year-old girl. Z Kinder Jugendpsychiatr Psychother 2019;47:168–70. DOI: https://doi.org/10.1024/1422-4917/a000613
Borkar D, Kiragub A W, Arensc A, Montaguec A J. A 7-week-old infant with serotonin syndrome. North American Congress of Clinical Toxicology ( NACCT) 2022. Clin Toxicol 2022;60:1–162. DOI: https://doi.org/10.1080/15563650.2022.2107776
Schult RF, Morris AJ, Picard L, et al. Citalopram overdose and severe serotonin syndrome in an intermediate metabolizing patient. Am J Emerg Med 2019;37:1993.e5-1993.e6. DOI: https://doi.org/10.1016/j.ajem.2019.06.038
Prakash S, Rathore C, Rana K, Patel H. Antiepileptic drugs and serotonin syndrome - A systematic review of case series and case reports. Seizure 2021;91:117–31. DOI: https://doi.org/10.1016/j.seizure.2021.06.004

How to Cite

Minghetti, S., Lazzerotti, A., Sala, D., Vimercati , C., Giudici, S., Florio, S., Formica, F., Zambrano, S., Agarwal, N., & Peruzzi, C. (2024). Neurotoxicity and PRES after severe citalopram intoxication in a 12-months-old baby. Emergency Care Journal. https://doi.org/10.4081/ecj.2024.12574
Copyright (c) 2024 the Author(s) Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.