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Eosinophilia and rebound neutropenia: case report A 48-year-old man developed eosinophilia during treatment with clozapine and rebound neutropenia following lithium discontinuation [routes and durations of treatments to reactions onsets not stated; not all outcomes stated]. The man had been diagnosed with schizophrenia 19 years previously. He had received electroconvulsive therapy and various medications, such as risperidone and haloperidol, but showed poor response. He was initiated on clozapine treatment (initially 12.5 mg/day, increased by 12.5 or 25 mg/day every 6–7 days) as the schizophrenia was treatment resistant and Positive and Negative Syndrome Scale (PANSS) score was 110. At the time of clozapine initiation, he received paliperidone 6 mg/day, levomepromazine 25 mg/day and haloperidol 3 mg/day, which decreased in a cross-titration regimen. He also received lithium 400 mg/day as his WBC count was lower than 4000 cells/mm3 before clozapine initiation. On day 12, he presented with a temperature of 39.8°C and a cough. By day 16, the leucocyte count (both neutrophils and eosinophils) increased. He was administered antibiotic therapy with ceftriaxone, but it was ineffective. On day 19, he was transferred to the hospital (current presentation) for detailed investigations. His admission laboratory tests revealed increased WBC count, neutrophil count, eosinophil count, platelet count, ALT, alkaline phosphatase, gamma-glutamyl transpeptidase (GGT), creatinine and C-reactive protein and decreased haemoglobin. At admission, his medications were as follows: lithium 400 mg/day, paliperidone 6 mg/day, haloperidol 3 mg/day and levomepromazine 25 mg/day. A chest CT revealed slight bilateral pleural effusion and pericardial effusion. On day 20, therapy with lithium was discontinued due to neutrophilia and damage to renal function. Also, ceftriaxone was changed to piperacillin/tazobactam due to liver damage. On day 20, his CRP and creatinine peaked. On day 22, WBCs, AST, neutrophils, ALT and GGT peaked. However, until day 29, the eosinophil count continued to rise. He also had bronchitis and hepatitis. A drug-induced reaction was suspected, and clozapine dosages was lowered to 75 mg/day starting on day 25, finally discontinuing it on day 30, and haloperidol was increased to 6 mg/day due to the increasing tendency toward eosinophilia. Following that, the man’s eosinophil count gradually reduced to within the normal range by day 40. However, the neutrophil and leucocyte counts also gradually reduced to within the normal ranges, dropping below the normal ranges by day 40 (rebound neutropenia). He was monitored for 10 consecutive days. By day 55, his leucocyte and neutrophil counts recovered. His psychotic symptoms deteriorated and his PANSS score increased to 95 despite using haloperidol at 6 mg/d on day 50, and no amelioration was observed with brexpiprazole at 2 mg/day and aripiprazole at 30 mg/day on day 80. Retrospective analysis of the drug-induced lymphocyte stimulation test was found to be positive for clozapine. K