Emergency and Toxicologycommon
A 34-year-old woman taking sertraline 100 mg daily for depression presents with two hours of agitation and profuse sweating. Two days earlier her general practitioner commenced tramadol for low back pain. Her temperature is 38.2°C, pulse 118/min and blood pressure 142/88 mmHg. On examination her pupils are dilated, her knee jerks are markedly brisk, and sustained dorsiflexion of the ankles produces repetitive rhythmic beating movements. Which one of the following is the most likely diagnosis?