Evidence map›Paper›PMID 41656390›Full record

ArticleNeurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology2026

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

Wen Zhao, Jinyu Shi, Anand Karthik Sarma, Jianwen Lin, Cui Wang, Lushuang Xie, Yi Liu

Abstract readCase Reports
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In one paragraph

Article in Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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4 · The record

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5 · Who and what money

Authors and funding

7 authors.

Wen Zhao *Department of Neurology, Central Hospital of Dalian University of Technology, Dalian, 116033, China.
Jinyu Shi *Department of Neurology, Central Hospital of Dalian University of Technology, Dalian, 116033, China.
Anand Karthik SarmaDepartment of Neurology, Section on Neurocritical Care, Wake Forest Baptist Health, Winston-Salem, NC, USA.
Jianwen LinDepartment of Neurology, Central Hospital of Dalian University of Technology, Dalian, 116033, China.
Cui WangDepartment of Neurology, Central Hospital of Dalian University of Technology, Dalian, 116033, China.
Lushuang XieCollege of Basic Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China.
Yi LiuDepartment of Neurology, Central Hospital of Dalian University of Technology, Dalian, 116033, China. letaliu@bjmu.edu.cn.ORCID http://orcid.org/0000-0002-6835-3713

Funding

Key Research and Development Program of Liaoning Province 2025ZXYYCR003Liaoning Revitalization Talents Program XLYC 1807083Science and Technology Innovation for Public Welfare Project of Dalian 2024JJ13PT051
6 · The paper itself

Abstract

backgroundMultiple system atrophy (MSA) is a neurodegenerative disease that affects the extrapyramidal, cerebellar, and autonomic nervous systems. In some patients, hypothalamic involvement can lead to impaired thermoregulation and hyponatremia. Duloxetine, a serotonin-norepinephrine reuptake inhibitor used for chronic pain, has rarely been linked to fever and syndrome of inappropriate antidiuretic hormone secretion (SIADH). CASE PRESENTATION: A 66-year-old man with clinically probable MSA and baseline hyponatremia (serum sodium 121.6 mmol/L) started duloxetine 30 mg/day for migrating pain. Within 24 h, he developed high fever (38.0-39.5 °C) without sweating, and serum sodium fell to 117 mmol/L despite oral sodium supplementation. Findings supported SIADH, with low plasma osmolality (269 mOsm/kg), inappropriately concentrated urine (404 mOsm/kg), and high 24-h urinary sodium (444.5 mmol). The infectious workup was largely unremarkable, and antibiotics did not improve either fever or hyponatremia. After duloxetine was discontinued, body temperature gradually returned to normal, sweating resumed, and serum sodium increased. He later developed aspiration-related pneumonia and died despite intensive care.

conclusionsDuloxetine may trigger fever and worsen hyponatremia due to SIADH in patients with MSA, possibly by increasing hypothalamic stress. Duloxetine should be used cautiously in MSA, with close monitoring of temperature and serum sodium, particularly in patients with pre-existing hyponatremia or suspected hypothalamic involvement.

Indexed as

Duloxetine HydrochlorideFeverInappropriate ADH SyndromeMultiple System AtrophyAgedHumansMaleDuloxetine HydrochlorideDuloxetineFeverHypothalamusMultiple system atrophySyndrome of inappropriate antidiuretic hormone secretion

Identifiers

PMID41656390

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