AI Article Synopsis
- Two young adults developed severe shock after starting clozapine for psychosis during a gastroenteritis outbreak, showing no troponin elevation.
- One patient was diagnosed with lymphocytic myocarditis and the other with eosinophilic myocarditis, leading to the first patient's death.
- The cases suggest that myocarditis can occur with standard clozapine doses and indicate a potential risk when combined with gastroenteritis symptoms; doctors should be cautious when prescribing clozapine under these conditions.
Article Abstract
We report that two young adult patients who were initiated with clozapine for severe psychosis during a hospital-wide gastroenteritis outbreak went into severe shock. Neither patient had troponin elevation. Each required left ventricular assist device support for myocarditis. Endomyocardial biopsy revealed lymphocytic myocarditis in one patient and eosinophilic myocarditis in the other. The former patient expired. Polymerase chain reaction testing was negative for Coxsackie virus. These two patients illustrate that myocarditis can occur at usual incipient doses and that there may be an epidemiologic risk associated with gastroenteritis. Although the white blood cell (WBC) count is expected to decrease with clozapine, these patients had persistently elevated WBC counts. In conclusion, physicians should exercise caution when prescribing clozapine, especially for those with diarrhea.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5161787 | PMC |
| http://dx.doi.org/10.3402/jchimp.v6.32683 | DOI Listing |
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