Key result
Clozapine use linked to reversible cardiotoxicity presenting as sepsis with LVEF reduced to 45%.
Why the study?
Clozapine-induced myocarditis is a rare but serious complication that may lead to cardiomyopathy and requires clinical awareness.
Case Report (n=1)
Clozapine-induced cardiotoxicity can present atypically as sepsis and requires prompt recognition and drug discontinuation to allow for recovery of systolic function.
Answers are grounded in this paper and cite their sources.
Clozapine cardiotoxicity may mimic sepsis with reversible systolic dysfunction; this single case leaves broader applicability and mechanisms open.
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.
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Khalid et al. (2019) conducted a case report in Schizophrenia (n=1). Clozapine was evaluated. Clozapine use in a 21-year-old male led to cardiotoxicity presenting as sepsis with reduced systolic function (45%), which normalized upon immediate discontinuation of the medication.
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