27th National Clinical Education Symposium Presentation Abstracts
29 APRIL 2025, MONDAY
13:00-14:00 POSTER PRESENTATION SESSION-2
Clozapine Induced Eosinophilic Myocarditis: A Case Report
Mustafa Onur Zeybek1, Halil İbrahim Yamaç1, Mahmut Selçuk2
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Show more (Affiliations)
1. Department of Psychiatry, Muğla Education and Research Hospital, Muğla, Türkiye
2. Department of Psychiatry, Muğla Sıtkı Koçman University, Muğla, Türkiye
DOI: 10.5080/kes27.abs127 Page 153
OBJECTIVE:This case report details presentation of myocarditis occurring on the 12th day of clozapine administration in a patient with treatment-resistant bipolar disorder manifesting as a psychotic manic episode, subsequently diagnosed as schizoaffective disorder. CASE :32-years-old, single, female patient with no medical history and complaints of grandiosity, diminished sleep requirement, erotomanic and persecutory delusions, admitted to the inpatient service with diagnosis of first attack psychotic manic episode. Patient demonstrated therapeutic unresponsiveness to lithium, olanzapine, risperidone, paliperidone and aripiprazole. On the 53rd day of hospitalization, while maintained on lithium 1200mg/day and olanzapine 20mg/day, it was planned to discontinue olanzapine and initiate clozapine. On day 12 of clozapine treatment, while taking a dose of 175mg/day clozapine, patient developed fever up to 38°c and reported no complaints other than fatigue, there were no findings other than hypotension and fever. Tests revealed CRP: 10,33 mg/L, WBC: 20110 g/L, Neutrophil: 17920 g/L, Eosinophil: 460 g/L. No active infection focus was found, echocardiography was normal. On day 15, hypotension and fever up to 40°c developed. Tests showed CRP: 139,87 mg/L, WBC: 19130 g/L, Neutrophil: 15550 g/L, Eosinophil: 830 g/L, Troponin T: 49,39 mg/mL. Echocardiography revealed a left ventricular ejection fraction of 40%, and clozapine was stopped due to suspected perimyocarditis. On day 18, tests revealed Eosinophil: 2190 g/L, Troponin T: 12,44 mg/mL and the patient's complaints regressed. On day 21, the values were Eosinophil: 4770 g/L, CRP: 11,03 mg/L, Troponin T: 4,68 mg/mL. Myocarditis was confirmed by subsequent cardiac MRI. Written informed consent was obtained from patient. DISCUSSION:In our case, echocardiography and CRP values were normal on the day the fever started. It was observed that eosinophil levels may not serve as a reliable early indicator, with eosinophilia potentially manifesting several days after elevation of troponin levels, and potentially continuing to increase even following the discontinuation of clozapine.