Practice question

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A 60-year-old man with a background of depression treated with citalopram presents with confusion and agitation 2 weeks after starting tramadol for back pain. On examination, he is sweating, tremulous, and has hyperreflexia and inducible clonus in his lower limbs. His temperature is 38.5°C and heart rate is 110 bpm. What is the most likely diagnosis?

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