Olanzapine
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Olanzapine Leucopenia and neutropenia: case report
A 31-year-old man developed leucopenia and neutropenia during treatment with olanzapine for hypomania. The heterosexual man presented for hypomania. He started receiving home treatment with olanzapine 10mg once nightly [route not stated] and clonazepam in the community. However, after unsuccessful period of home treatment, he was admitted to an acute psychiatric inpatient ward. Upon admission, he was alert and afebrile. He was noted to have oral candidiasis. Blood examination showed mild pancytopenia, elevated haemoglobin, white cell count of 3.2 × 109/L, neutrophils of 1.86, lymphocytes of 0.86 and platelets of 119 × 109/L [not all units stated]. Nystatin was added to his treatment. He was continued on olanzapine 15mg once nightly and clonazepam. Sodium valproate was added to his treatment as a mood stabiliser. After seven days, repeat blood examination showed haemoglobin of 119 g/L, WBC of 2.2 × 109/L, neutrophils of 1.08, lymphocytes of 0.69 and platelets of 101 × 109/L. His oral candidiasis improved. However, he developed a fungal toenail infection. A blood film exhibited normochromic, a few macrocytes and marked rouleaux formation and normocytic red cells. It was considered that the neutropenia and mild leucopenia were due to olanzapine [duration of treatment to reaction onset and outcome not stated]. Further, he was found positive for HIV. He was started on acyclovir. Also, cotrimoxazole was started for pneumocystis pneumonia prophylaxis. His sexual history revealed that he had had unprotected sex with several female partners 10 years ago. His regular partner tested HIV negative. Later, he was developed mania secondary to varicella zoster virus encephalitis. He received treatment with aciclovir for HIV infection and valganciclovir for varicella zoster virus prophylaxis. Later, he started antiretroviral therapy with fix-drug combination of abacavir, lamivudine and dolutegravir. Eventually, his clinical condition improved, and he was discharged home. After three months of the treatment, his viral load decreased. But his regular partner found positive for HIV infection. George O, et al. Mania presenting as a VZV encephalitis in the context of HIV. BMJ Case Reports 13: 230512, No. 9, 7 Sep 2020. Available from: URL: http:// doi.org/10.1136/bcr-2019-230512
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Reactions 28 Nov 2020 No. 1832
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