{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T13:58:11Z","timestamp":1769003891045,"version":"3.49.0"},"reference-count":23,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2021,1,1]],"date-time":"2021-01-01T00:00:00Z","timestamp":1609459200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["SAGE Open Medical Case Reports"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:p> Clinicians and researchers have reported an array of neurological abnormalities in coronavirus disease 2019 (COVID-19), and while serotonin excess has been observed we are unaware of reports of central nervous system serotonin toxicity in COVID-19. We present two cases that resemble serotonin syndrome in COVID-19, but without identifiable inciting medications. A 54-year-old with multiple sclerosis and diabetes mellitus presented with altered mental status. His altered sensorium was attributed to diabetic ketoacidosis, but his condition quickly deteriorated with fever to 105\u2009degrees Fahrenheit, rigidity in all extremities, inducible clonus, and hyperreflexia. He was intubated and was treated for possible meningitis and seizure. Neurologic workup was negative for acute pathology. Despite acetaminophen, his core temperature remained elevated to 105\u2009degrees Fahrenheit. He was treated with external cooling and cyproheptadine and within 48\u2009h, his fever, rigidity, hyperreflexia, and clonus resolved. He was extubated and discharged home on day 14. A 72-year-old with hyperlipidemia was admitted with tremors, 4\u2009days after testing positive for COVID-19. His symptoms rapidly worsened, and he was transferred to the Intensive Care Unit on day 3 in extremis, febrile to 104.4\u2009degrees Fahrenheit, heart rate of 180 beats per minute, and apparent whole body myoclonus. He was intubated and developed fever refractory to acetaminophen requiring external cooling. Extensive neurologic workup was negative. He received cyproheptadine and slowly improved. He was extubated and discharged to rehab on day 11. These cases represent a unique presentation in COVID-19 that must be considered and requires a high index of suspicion. <\/jats:p>","DOI":"10.1177\/2050313x211032089","type":"journal-article","created":{"date-parts":[[2021,7,8]],"date-time":"2021-07-08T07:31:07Z","timestamp":1625729467000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":10,"title":["Unprovoked serotonin syndrome-like presentation of SARS-CoV-2 infection: A small case series"],"prefix":"10.1177","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9415-0549","authenticated-orcid":false,"given":"Philip","family":"Keith","sequence":"first","affiliation":[{"name":"Critical Care Medicine, Lexington Medical Center, West Columbia, SC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marc","family":"Saint-Jour","sequence":"additional","affiliation":[{"name":"Internal Medicine, Lexington Medical Center, West Columbia, SC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank","family":"Pusey","sequence":"additional","affiliation":[{"name":"Neurology, Lexington Medical Center, West Columbia, SC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeremy","family":"Hodges","sequence":"additional","affiliation":[{"name":"Critical Care Clinical Pharmacy, Novant Health Forsyth Medical Center, Winston-Salem, NC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Farid","family":"Jalali","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Saddleback Medical Group, Laguna Hills, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L Keith","family":"Scott","sequence":"additional","affiliation":[{"name":"Division of Trauma and Surgical Critical Care, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA"},{"name":"Participating Study Center, Lexington Medical Center, West Columbia, 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