Serotonin syndrome is potentially life-threatening syndrome associated with excessive serotonergic activity within the central nervous system. Serotonin syndrome is associated with medication use, drug interactions, and overdose. While serotonin syndrome is often associated with the use of selective serotonin inhibitors (SSRI), an increasing number of reports are being presented involving the use of tramadol. With tramadol increasing popularity, the goal of this article is to make physicians more alert and aware of this potential side effect. Serotonin syndrome may be difficult to diagnose. A case of serotonin syndrome caused by the combination of tramadol and antidepressants in a patient with advanced cancer is presented and discussed. The importance of early diagnosis of this syndrome is emphasized.

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Hypertrophic osteoarthropathy (HOA) is a syndrome that consists of periostitis, digital clubbing, and painful polyarthropathy. The management and prognosis of HOA is dependent on the underlying disease process. Recognising and treating it accordingly will reduce the symptom burden of patients. We present a case of a patient diagnosed with non-small cell lung cancer and HOA suffering from severe pain, and review specific therapies for the management of HOA-related pain.