Serotonin syndrome is a potentially fatal increase in serotonergic activity in both the central nervous system and peripheral nervous system. The etiology can vary from therapeutic drug use, deliberate overdose, or drug interactions that all lead to an increase in serotonin activity. There are some drugs from different classes that can cause serotonin syndrome either alone at high doses or when combined. We present here a case of an 82-year-old female who presented to the emergency room with high-grade fever, loose stools, burning micturition, and tachycardia. Her current medications included sertraline for depression. She was initially treated on the floor for urosepsis and subsequently managed with antibiotic therapy consisting of cephalosporins. She did not improve so her antibiotics were modified and she was then started on linezolid. Within the first 24 h of taking linezolid, the patient had a rapid clinical deterioration manifesting as restlessness, diaphoresis, tremor, shivering, myoclonus, and high fever (40°C). She also had an acute decompensation of her mental status with disorientation and confusion. As a result, she was transferred to intensive care unit. On clinical examination, she had rigidity and hyperreflexia all the four limbs. Babinski sign was positive. Laboratory test results were unremarkable for sepsis. Sertraline and linezolid were stopped. Within 24 h, the patient's mental status had improved. By the 2 nd day on this treatment regimen, the patient's function returned to baseline, and she was discharged from the hospital. Nevertheless, in our case, the administration of sertraline did not reveal any symptomatic interaction, as the serotonin syndrome was induced only after the addition of linezolid to the treatment regimen. This patient was diagnosed with serotonin syndrome.

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Objectives: Coronavirus disease 2019 (COVID-19) is a recently described infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing various intensive care unit (ICU) admissions and deaths. Common laboratory values may provide key insights into patients with COVID-19, and may predict the morbidity and outcome. The aim of this study was to evaluate the relation of elevated D-dimer levels on mortality of patients admitted to ICU with COVID-19. Material and Methods: All ICU patients with laboratory confirmed COVID-19 were retrospectively enrolled in Sevenstar Hospital, Nagpur from 27 July, 2020, to 30 October, 2020. D-dimer levels on admission, on Day 3 and Day 5, were collected in all ICU patients and death events were collected. The subjects were divided into two groups discharged and expired. Then, the D-dimer levels between two groups were compared to assess the predictive value of D-dimer level and mortality in hospitals. Results: A total of 101 eligible patients were enrolled in the study. Thirty-one deaths occurred during hospitalisation. Patients who expired had on admission D-dimer levels of 2729 ± 3243 ng/mL while those discharged had D-dimer values of 973 ± 1553 ng/mL (P < 0.007). D-dimer of expired patients on Day 3 was 3206.5 ± 3338.8 and of discharged patients was 828.8 ± 1268.8 (P = 0.001). D-dimer of expired patients on Day 5 was 5184. 5 ± 3386.1 versus discharged patients was 588.7 ± 645.5 (P < 0.0001). Number of Days in ICU for patients who expired was 14.22 ± 6.7 while for those who survived 7.6 ± 5.9. Conclusion: We conclude that SARS-CoV-2 infected patients with increasing trend of D-dimer (from admission to day 5) have worse clinical outcomes (all-cause mortality), and thus, measurement of D-dimers on admission and its trend can guide clinical decision-making.

Leptospirosis is a zoonotic disease associated with mild to severe pulmonary complications. On rare occasions, ARDS can be secondary to tropical disease. Accordingly, a history should include travel to endemic regions. Acute respiratory distress syndrome (ARDS), characterized by hypoxemic respiratory failure, is associated with a high mortality of and is precipitated by both direct and indirect pulmonary insults. Treatment is largely supportive, consisting of lung protective ventilation and occasionally requires Extra-corporeal membrane oxygenation (ECMO) and thereby necessitating Intensive Care Unit (ICU) admission. We describe a case of a 18-year-old male with undiagnosed leptospirosis, presenting with fever and severe hypoxemic respiratory failure, returning from a holiday. He was intubated and received lung protective ventilation followed by prone ventilation which failed. His condition improved after ECMO and antibiotic added empirically. This case illustrates the rare Complication of ARDS from leptospirosis, which may need ECMO and the importance of taking a travel history.