Risperidone
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Acute eosinophilic pneumonia: case report A 64-year-old man developed acute eosinophilic pneumonia during treatment with risperidone for psychotic symptoms. The man, who also had a history of alcoholism and paranoid symptoms, had been receiving risperidone 3mg daily [route not stated] for approximately 6 months when he presented to the emergency department with evidence of mild respiratory distress, fever, and pleuritic chest pain in his lower left pulmonary field. On admission, he was febrile with mild respiratory distress and was placed on oxygen. His oxygen saturation was 92% on ambient air. He had reduced breath sounds of both lung bases and laboratory studies showed a leukocyte count of 9660 /µL (eosinophils 2.3%, lymphocytes 13% and neutrophils 73%), platelet count 290 000 /µL, haematocrit 39%, ESR 83, and CRP 47.3 mg/L. There was rightside blunting of his costophrenic angle due to pleural effusion and bilateral peripheral infiltrates seen on his chest x-ray. He was initially considered to have pneumonia with parapneumonic effusion and was treated with clindamycin and ceftriaxone. Risperidone was withdrawn due to his fever, and his fever did not respond to the antibiotics. He was then given IV ceftazidime and metronidazole and doxycycline. A chest CT was conducted and he was found to have bilateral pleural effusion and pulmonary infiltrates in his lingula and middle lobe. Although he still had a fever, a bronchoscopy was performed for a bronchoalveolar lavage specimen. This specimen contained 42.6% eosinophils and 3.4% lymphocytes which indicated acute eosinophilic pneumonia. Risperidone was considered the most probable causative factor and amisulpride was initiated instead when the man’s fever resolved. A second bronchoalveolar lavage conducted a month after his discharge did not contain any eosinophils. On his psychiatry follow-up, he did not indicate clinical recurrence of his psychotic symptoms. Author comment: "We present a case of [acute eosinophilic pneumonia], induced by the second-generation antipsychotic agent, risperidone." Rizos E, et al. Risperidone-induced acute eosinophilic pneumonia. In Vivo 27: 803095294 651-653, No. 5, Sep-Oct 2013 - Greece
0114-9954/13/1477-0001/$14.95 Adis © 2013 Springer International Publishing AG. All rights reserved
Reactions 9 Nov 2013 No. 1477
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