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A 14-year-old boy is brought to the Emergency Department by

A 21-year-old woman with a history of seasonal allergies and major depressive disorder presents to the emergency department reporting chills and muscle soreness approximately 3 hours after ingesting methylenedioxymethamphetamine (MDMA). She is visibly agitated but able to convey her history. She does not take any other illicit substance, but she notes taking an 11 mg oral extended-release tablet of brompheniramine earlier this morning. She describes ongoing episodes of uncontrollable sneezing but no chills or soreness prior to taking MDMA. She attests to continued adherence with a daily regimen of 60 mg oral tablet fluoxetine. Her temperature is 102.1°F with a regular pulse of 110 beats/min. Physical exam reveals dilated pupils, persistent ocular clonus, diaphoresis, and sustained ankle jerking after dorsiflexion of the feet bilaterally. Her lungs are clear. There is no sign of edema in the face or limbs. Which of the following is the most likely diagnosis? Anaphylaxis Influenza Serotonin syndrome Somatic symptom disorder

 
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