HEMICHOREA INDUCED BY SERTRALINE

Case Report and Literature Review

Aldinio V., Persi G., Bres Bullrich M., Sánchez de Paz P., Da Prat G., Parisi V., Rojas G., Gatto E.

 Sanatorio de la Trinidad Mitre, Ciudad Autónoma de Buenos Aires, Argentina

Objectives To describe hemichorea in a patient with sertraline treatment

Background Hemichorea (HC) is a unilateral continuous, random and proximal movement on one side of the body. HC is associated with nonketotic hyperglycemia and is less frequently related to stroke involving striatum. Drug induced HC is a rare syndrome related to serotonin selective reuptake inhibitors (SSRIs).

Methods There was included a woman who developed HC after being treated with sertraline. Literature review.

Results A 65 years old woman, with personal history of irritable bowel and smoking, noticed a postural instability and irritability in December 2015. A depressive syndrome was diagnosed on March and she was started on sertraline 50 mg/day. One week later, she developed HC, diarrhea, stomatitis. An extensive investigation to exclude other causes was conducted. Brain MRI revealed no basal ganglia lesions. Laboratory tests, including complete blood count, renal, liver, and thyroid function, vitamin B12, folic acid, VDRL, HIV, prolactin, cortisol, carcinoembryonic antigen, CA 15.3, CA 19.9, CA 125, VSG, PCR, ceruloplasmine, anti-endomysium, Anti RI, Yo, Hu, FAN, P-ANCA , C-ANCA, rheumatoid factor, CSF protein, onconeural antibodies were normal/negative. Echocardiogram, Doppler ultrasound of neck vessels, CT scan of thorax, abdomen and pelvis, normal. High and low video endoscopy with biopsy: negative. Sertraline was withdraw with clinical improvement.

Conclusion The incidence of movement disorders caused by SSRIs is unknown. After a literature review, we failed to identify sertraline induced HC. Fluoxetine was reported associated with HC. In our patient temporal association and an extensive clinical assessment discarded other causes of HC and supported a drug induced involuntary movement. We hypothesized that a serotonergic transmission could impair striatum pathways and induce HC.