Anna Filippidou

Purpose: To present a case of mirtazapine associated seizures in an adolescent boy and to conduct a systematic review of published cases of seizures occurring in association with mirtazapine use. Methods: We presented our case and conducted a systematic search, following the PRISMA Statement, in the PubMed and Scopus databases for mirtazapine associated seizure cases, until 12th September 2026. Results: A 15-year-old patient arrived at the emergency department of our hospital via ambulance due to a generalized tonic-clonic seizure occurring 15 minutes prior. The toxicology report of his urine sample was positive for mirtazapine metabolites. He was self-administering mirtazapine for an unknown amount of time. This was the most likely cause of the generalized tonic-clonic seizures. No further seizures occurred during hospitalization. Our systematic search yielded 7 published cases. The median age was 50 years. The dosage of mirtazapine ranged from 7.5 mg to 60 mg per day. Excluding one case with an overdose, seizures presented a few days after mirtazapine initiation or dosage escalation—three cases presented with focal seizures and 3 cases with generalized seizures. Two cases had a positive history of epilepsy, and 4 cases were on other medications that can lower the seizure threshold. In most cases, withdrawal of mirtazapine was sufficient for seizure resolution. Conclusion: The available evidence cannot establish a causative relationship between mirtazapine and seizures. The temporal association observed in several cases suggests that physicians should remain vigilant for seizure occurrence, particularly in individuals with pre-existing epilepsy or other potential seizure risk factors.

Staphylococcal scalded skin syndrome (SSSS) is a toxin-mediated pediatric emergency requiring rapid intervention. We present the case of a 6-year-old male who exhibited acute-onset erythroderma, superficial scaling, and a positive Nikolsky sign. Despite initiating standard empiric intravenous cloxacillin and supportive skin care, the patient demonstrated a delayed clinical response. Due to the appearance of new desquamative lesions, adjuvant clindamycin was added on day three. Vancomycin was later added on day seven of hospitalization, followed by cessation of new lesions and a successful discharge on day thirteen. This case highlights a delayed response to the first-line treatment and emphasizes the clinical importance of the early reevaluation of SSSS management. Moreover, we conducted a brief review of the current literature.