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: 44
PDF: 22
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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.

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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
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