Fever and syndrome of inappropriate antidiuretic hormone secretion in a patient with multiple system atrophy after treatment with duloxetine

Abstract Background: Multiple system atrophy (MSA) is characterized by involvement of the extrapyramidal system, cerebellum and autonomic nervous system. Hypothalamus can also be affected with fever and hyponatremia, and is more vulnerable when combined with certain conditions, such as infection. Duloxetine was prescribed for chronic pain as a dual inhibitor of serotonin (5-HT) and norepinephrine reuptake, resulting in the rare side effects of fever and syndrome of inappropriate antidiuretic hormone secretion (SIADH). Case presentation: This article reports a rare case of fever and SIADH in a patient with multiple system atrophy after treatment with duloxetine, and analyzes potential pathophysiological mechanism. Conclusions : For MSA patients with suspected hypothalamic involvement, drugs such as duloxetine that could potentially exacerbate the hypothalamic burden through neurotransmitters involved neural circuits should be evaluated carefully before prescription.