Clozapine-Induced Cardiotoxicity Presenting as Sepsis: A Case Report and Literature Review
Clozapine is an atypical antipsychotic agent indicated in the treatment of medication-resistant schizophrenia. It is often reserved as a last line of treatment owing to the potential for serious and potentially life-threatening side effects, the most serious being agranulocytosis requiring close hem...
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doaj-f73c008e2720483cbb375edc85c6d1802020-11-25T00:30:56ZengHindawi LimitedCase Reports in Medicine1687-96271687-96352019-01-01201910.1155/2019/34351083435108Clozapine-Induced Cardiotoxicity Presenting as Sepsis: A Case Report and Literature ReviewMazin Khalid0Oluwole Jegede1Vijay Gayam2Ying Chi Yang3Binav Shrestha4Amrendra Mandal5Osama Mukhtar6Pavani Garlapati7Mowyad Khalid8Alix Dufresne9Department of Medicine, Interfaith Medical Center, Brooklyn, NY, USADepartment of Psychiatry, Interfaith Medical Center, Brooklyn, NY, USADepartment of Medicine, Interfaith Medical Center, Brooklyn, NY, USADepartment of Medicine, Interfaith Medical Center, Brooklyn, NY, USADepartment of Medicine, Interfaith Medical Center, Brooklyn, NY, USADepartment of Medicine, Interfaith Medical Center, Brooklyn, NY, USADepartment of Medicine, Interfaith Medical Center, Brooklyn, NY, USADepartment of Medicine, Interfaith Medical Center, Brooklyn, NY, USADepartment of Medicine, Detroit Medical Center, Wayne State University, Detroit, MI, USADepartment of Cardiology, Interfaith Medical Centre, Brooklyn, NY, USAClozapine is an atypical antipsychotic agent indicated in the treatment of medication-resistant schizophrenia. It is often reserved as a last line of treatment owing to the potential for serious and potentially life-threatening side effects, the most serious being agranulocytosis requiring close hematological monitoring and possible discontinuation of the medication from further use in the patient even when the agranulocytosis resolves. Other complications of clozapine include sedation, weight gain, elevated triglyceride levels, postural hypotension, and tachycardia. However, the potentially serious complication of myocarditis, though rare (with an incidence of 3%), may lead to cardiomyopathy as described in our present case. We present a 21-year-old patient who was started on clozapine for management of schizophrenia. He developed fever and tachycardia and was admitted to the medical unit on intravenous antibiotics for management of sepsis as he met the criteria for systemic inflammatory response syndrome. His labs revealed an elevated troponin and trending eosinophilia, which, in the context of clozapine use, raises the suspicion of clozapine cardiotoxicity. Echocardiogram showed reduced systolic function (45%). Clozapine was immediately discontinued, and his repeat echocardiogram showed normalization of his systolic function. In view of the increased prevalence of psychiatric illnesses, internists should be aware of rare but potentially life-threatening side effects.http://dx.doi.org/10.1155/2019/3435108 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Mazin Khalid Oluwole Jegede Vijay Gayam Ying Chi Yang Binav Shrestha Amrendra Mandal Osama Mukhtar Pavani Garlapati Mowyad Khalid Alix Dufresne |
spellingShingle |
Mazin Khalid Oluwole Jegede Vijay Gayam Ying Chi Yang Binav Shrestha Amrendra Mandal Osama Mukhtar Pavani Garlapati Mowyad Khalid Alix Dufresne Clozapine-Induced Cardiotoxicity Presenting as Sepsis: A Case Report and Literature Review Case Reports in Medicine |
author_facet |
Mazin Khalid Oluwole Jegede Vijay Gayam Ying Chi Yang Binav Shrestha Amrendra Mandal Osama Mukhtar Pavani Garlapati Mowyad Khalid Alix Dufresne |
author_sort |
Mazin Khalid |
title |
Clozapine-Induced Cardiotoxicity Presenting as Sepsis: A Case Report and Literature Review |
title_short |
Clozapine-Induced Cardiotoxicity Presenting as Sepsis: A Case Report and Literature Review |
title_full |
Clozapine-Induced Cardiotoxicity Presenting as Sepsis: A Case Report and Literature Review |
title_fullStr |
Clozapine-Induced Cardiotoxicity Presenting as Sepsis: A Case Report and Literature Review |
title_full_unstemmed |
Clozapine-Induced Cardiotoxicity Presenting as Sepsis: A Case Report and Literature Review |
title_sort |
clozapine-induced cardiotoxicity presenting as sepsis: a case report and literature review |
publisher |
Hindawi Limited |
series |
Case Reports in Medicine |
issn |
1687-9627 1687-9635 |
publishDate |
2019-01-01 |
description |
Clozapine is an atypical antipsychotic agent indicated in the treatment of medication-resistant schizophrenia. It is often reserved as a last line of treatment owing to the potential for serious and potentially life-threatening side effects, the most serious being agranulocytosis requiring close hematological monitoring and possible discontinuation of the medication from further use in the patient even when the agranulocytosis resolves. Other complications of clozapine include sedation, weight gain, elevated triglyceride levels, postural hypotension, and tachycardia. However, the potentially serious complication of myocarditis, though rare (with an incidence of 3%), may lead to cardiomyopathy as described in our present case. We present a 21-year-old patient who was started on clozapine for management of schizophrenia. He developed fever and tachycardia and was admitted to the medical unit on intravenous antibiotics for management of sepsis as he met the criteria for systemic inflammatory response syndrome. His labs revealed an elevated troponin and trending eosinophilia, which, in the context of clozapine use, raises the suspicion of clozapine cardiotoxicity. Echocardiogram showed reduced systolic function (45%). Clozapine was immediately discontinued, and his repeat echocardiogram showed normalization of his systolic function. In view of the increased prevalence of psychiatric illnesses, internists should be aware of rare but potentially life-threatening side effects. |
url |
http://dx.doi.org/10.1155/2019/3435108 |
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