Quetiapine
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Interstitial lung disease: case report A 54-year-old man developed interstitial lung disease during the treatment with quetiapine for schizophrenia [route and duration of treatment to reaction onset not stated]. The man presented with psychotic exacerbation. He had a significant history of schizophrenia involving paranoid delusions and aggression from the last 34 years. He had been experiencing auditory hallucinations for the last 15 days. Additionally, he also reported shortness of breath, cough, sputum and a high fever that started one week before the admission. The psychiatric examination showed that he had increased psychomotor activity, decreased self-care, paranoid delusions, and auditory and visual hallucinations. Diffuse inspiratory rales in the bilateral middle and lower regions of the lungs were seen in the respiratory examination. He had a history of smoking addiction. Following vital signs were reported BP 110/70mm Hg, body temperature 37.8°C (axillary), pulse rate 112 beats/min and RR 26 breaths/min. A mild increase in CRP and a mild level of leukocytosis were noted in laboratory tests. Arterial blood gas analysis revealed pH 7.46, PaO2 92.6mm Hg, PCO2 32.8mm Hg, bicarbonate concentration 22.9 mmol/L and oxygen saturation of 89%. He had been receiving clozapine, aripiprazole, amisulpride and quetiapine 300 mg/day for 5 months. Chest-X-ray showed infiltrated areas. Centrilobular nodular appearances of peribroncovascular diffuse ground glass density involving both lower lobes were observed in the thorax CT scan. Pulmonary function tests suggested a restrictive pattern and decreased diffusion capacity. The man was firstly suspected to have pneumonia, and he was initiated with moxifloxacin. Bronchoscopy revealed the presence of purulent secretions. In bronchoalveolar lavage 20% alveolar-macrophage, 10% lymphocyte and 70% neutrophils were observed. Polymorphonuclear lymphocytes (PNL) and labile cocci were detected in tracheal aspirate culture. The response was not adequate to previous medical therapy; therefore, therapy was substituted with piperacillin/tazobactam. Since he had been using other antipsychotics for a very long time and quetiapine was the last drug exposure before the onset of his symptoms, a possible correlation between interstitial lung disease and quetiapine was suspected. Within approximately 10 days, the adequate response was obtained in the laboratory and clinical parameters with a decrease in cough and normal lung auscultations. Regression was seen in alveolar infiltrations s observed in chest-X-ray and high resolution CT scan. Topcuoglu M, et al. Interstitial lung disease due to quetiapine: Case report and literature review. Duzce Medical Journal 22: 140-142, No. 2, Jan 2020. Available from: URL: 803502192 http://doi.org/10.18678/dtfd.732586
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Reactions 19 Sep 2020 No. 1822
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