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Monteleone F, Gonçalves M, Fonseca L, Simões S, Gonçalves A, Machado E, Fonseca J. Clozapine-Induced Eosinophilia: a Case Report. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2023; 52:161-164. [PMID: 37500239 DOI: 10.1016/j.rcpeng.2021.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 04/21/2021] [Indexed: 07/29/2023]
Abstract
INTRODUCTION Clozapine is an atypical antipsychotic drug eligible for treatment-resistant schizophrenia. It frequently represents the best and the only choice in resistant schizophrenia. However, its use is feared by many professionals due to its possible adverse effects, such as eosinophilia. CASE REPORT We report a case of a young white male suffering from treatment-resistant schizophrenia who rapidly developed eosinophilia after starting clozapine. DISCUSSION We present a case of a 26-year-old white man diagnosed with schizophrenia with poor clinical response to several antipsychotics owing to which clozapine was started. Psychotic symptoms improved dramatically but a progressively ascendant eosinophilia was reported during serial haematological analyses. The patient remained physically asymptomatic. An exhaustive assessment with ancillary diagnostic tests revealed no cause for eosinophilia. Thus, a diagnosis of clozapine-induced eosinophilia was made. The drug was discontinued and eosinophil count progressively returned to normal but psychotic symptoms worsened. CONCLUSIONS Clozapine treatment is frequently feared due to its possible side effects and complications, delaying its use in refractory schizophrenia. Also, to our knowledge, there are no specific guidelines on how to manage haematological side effects such as eosinophilia. This is problematic as, in some cases, it may lead to an unnecessary withdrawal of clozapine with a worsening of psychotic symptoms. We present a brief discussion of the recent literature on the subject.
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Affiliation(s)
- Francesco Monteleone
- Psychiatry and Mental Health Department of Hospital Senhora da Oliveira, Guimarães, Portugal.
| | | | - Luís Fonseca
- Psychiatry and Mental Health Department of Hospital Senhora da Oliveira, Guimarães, Portugal
| | - Sónia Simões
- Psychiatry and Mental Health Department of Hospital Senhora da Oliveira, Guimarães, Portugal
| | - Andreia Gonçalves
- Psychiatry and Mental Health Department of Hospital Senhora da Oliveira, Guimarães, Portugal
| | - Eduarda Machado
- Psychiatry and Mental Health Department of Hospital Senhora da Oliveira, Guimarães, Portugal
| | - João Fonseca
- Psychiatry and Mental Health Department of Hospital Senhora da Oliveira, Guimarães, Portugal
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Aguglia A, Parisi VM, Arduino G, Amerio A, Costanza A, Serafini G, Amore M. Clozapine in a Young Female with Drug-Resistant Schizophrenia: A Case Report of Development of Serositis. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2023; 22:313-316. [PMID: 35331125 DOI: 10.2174/1871527321666220324121207] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 12/29/2021] [Accepted: 01/17/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Clozapine may be considered the first-line option for treatment-resistant schizophrenia (TRS), a condition that occurs in more than 30% of patients with schizophrenia. Despite its efficacy for treating TRS, clozapine use is limited by the occurrence of several adverse effects in more than 70% of cases. Clozapine does not typically affect lung function, although a few cases have been reported in the literature. CASE PRESENTATION To gain a better understanding of this rare event, here we report the case study of a young female with TRS, who was treated with clozapine and developed medium and bilateral pleural effusion relief with contiguous atelectasis and polyserositis. Two weeks after stopping clozapine, the follow-up chest scan showed complete remission of the pulmonary condition. We postulate that clozapine might have caused, in this case, a specific immunoinflammatory response leading to serosal complications. CONCLUSION Although the underlying mechanisms of this adverse effect are not completely understood, early manifestations, such as benign eosinophilia, fever, and flu-like symptoms need to be considered a potential warning to facilitate an early diagnosis and carefully manage pulmonary complications related to clozapine treatment.
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Affiliation(s)
- Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Valentina Maria Parisi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Gabriele Arduino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessandra Costanza
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Monteleone F, Gonçalves M, Fonseca L, Simões S, Gonçalves A, Machado E, Fonseca J. Clozapine-Induced Eosinophilia: a Case Report. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2021; 52:S0034-7450(21)00080-9. [PMID: 34167790 DOI: 10.1016/j.rcp.2021.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 04/21/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Clozapine is an atypical antipsychotic drug eligible for treatment-resistant schizophrenia. It frequently represents the best and the only choice in resistant schizophrenia. However, its use is feared by many professionals due to its possible adverse effects, such as eosinophilia. CASE REPORT We report a case of a young white male suffering from treatment-resistant schizophrenia who rapidly developed eosinophilia after starting clozapine. DISCUSSION We present a case of a 26-year-old white man diagnosed with schizophrenia with poor clinical response to several antipsychotics owing to which clozapine was started. Psychotic symptoms improved dramatically but a progressively ascendant eosinophilia was reported during serial haematological analyses. The patient remained physically asymptomatic. An exhaustive assessment with ancillary diagnostic tests revealed no cause for eosinophilia. Thus, a diagnosis of clozapine-induced eosinophilia was made. The drug was discontinued and eosinophil count progressively returned to normal but psychotic symptoms worsened. CONCLUSIONS Clozapine treatment is frequently feared due to its possible side effects and complications, delaying its use in refractory schizophrenia. Also, to our knowledge, there are no specific guidelines on how to manage haematological side effects such as eosinophilia. This is problematic as, in some cases, it may lead to an unnecessary withdrawal of clozapine with a worsening of psychotic symptoms. We present a brief discussion of the recent literature on the subject.
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Affiliation(s)
- Francesco Monteleone
- Psychiatry and Mental Health Department of Hospital Senhora da Oliveira, Guimarães, Portugal.
| | | | - Luís Fonseca
- Psychiatry and Mental Health Department of Hospital Senhora da Oliveira, Guimarães, Portugal
| | - Sónia Simões
- Psychiatry and Mental Health Department of Hospital Senhora da Oliveira, Guimarães, Portugal
| | - Andreia Gonçalves
- Psychiatry and Mental Health Department of Hospital Senhora da Oliveira, Guimarães, Portugal
| | - Eduarda Machado
- Psychiatry and Mental Health Department of Hospital Senhora da Oliveira, Guimarães, Portugal
| | - João Fonseca
- Psychiatry and Mental Health Department of Hospital Senhora da Oliveira, Guimarães, Portugal
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