Abstract

To the Editor:

With our specific patient, clinical variables resulted in a broad differential diagnosis. We agree that her presentation was worrisome for neuroleptic malignant syndrome and serotonin syndrome, which we believe were effectively excluded on the basis of clinical presentation and subsequent laboratory data. Our hospital's protocol for lithium measurement is done with a "gold top" serum separator tube that contains no additives, thereby minimizing the risk for false-positive results. We did not include an additional lithium level that followed the overall trend. We appreciate this inquiry and agree atypical serotonin syndrome and mild neuroleptic malignant syndrome could have easily been valid diagnoses. What we hope to illustrate from this case is the necessity for a thorough investigation of all possible diagnoses when a patient's presentation is less than clear.