Clozapine
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Clozapine Pneumonitis: case report
A 53-year-old woman developed pneumonitis during treatment with clozapine for schizoaffective disorder. The woman was hospitalised for being no longer able to appropriately utilize food, clothing and shelter. She had a significant history of schizoaffective disorder bipolar subtype. At the time of admission, she had been receiving treatment with fluphenazine 20 mg/day along with various concomitant medications. In the first week of hospitalisation, she developed persistent psychosis even after fluphenazine therapy. Hence, fluphenazine was switched to olanzapine 30mg. During the fourth week of hospitalisation, her psychosis remained refractory. She exhibited lack of efficacy with fluphenazine and olanzapine, while being treated for schizoaffective disorder. Therefore, her treatment with olanzapine was changed to clozapine [route and initial dosage not stated]. However, on day 11 of clozapine therapy, she developed sepsis-like symptoms at the dose of 250 mg/day of clozapine. Her symptoms manifested as chest pain, fever, chills, tachycardia and tachypnea. Subsequent electrocardiogram showed a negative result for signs of acute coronary syndrome. Thereafter, a chest x-ray was performed which showed peribronchial vascular opacities in the left lung base and perihilar region. This finding was suspicious of pneumonia. The woman was treated with vancomycin, piperacillin/tazobactam along with paracetamol [acetaminophen] for pyrexia. Additionally, clozapine was discontinued due to risk for neutropenia in the setting of a possible acute infection. Her vital signs stabilised and leucocytosis resolved with antibiotics treatments and after 24 hours of discontinuation of clozapine. She received levofloxacin with presumed resolving pneumonia. The woman again started receiving treatment with clozapine 200mg. She developed chest pain, chills and sialorrhea within hours of restarting clozapine. As a corrective measure (empiric treatment), she received nitroglycerin without any improvement. A repeat electrocardiogram was still negative for signs of the acute coronary syndrome. Her other laboratory tests were noted to be normal. Her clozapine therapy was discontinued. Within 24 hours of discontinuation of clozapine, her symptoms resolved. Therefore, It was concluded that, she had developed clozapine-induced pneumonitis. Chest x-ray 48 hours after stopping clozapine revealed markedly improved lungs fields almost completely clear of prior opacities. Subsequently, she started receiving risperidone and paliperidone [paliperidone palmitate]. Thereafter, she was discharged without recurrence of fever or other signs of pneumonitis. Based on these findings and clinical presentation, it was confirmed that, she developed pneumonitis associated with clozapine. Torrico T, et al. Clozapine-Induced Pneumonitis: A Case Report. Frontiers in Psychiatry 11: 2020. Available from: URL: http://doi.org/10.3389/ fpsyt.2020.572102
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