Generic placeholder image

CNS & Neurological Disorders - Drug Targets


ISSN (Print): 1871-5273
ISSN (Online): 1996-3181

Case Report

Clozapine in a Young Female with Drug-Resistant Schizophrenia: A Case Report of Development of Serositis

Author(s): Andrea Aguglia*, Valentina Maria Parisi, Gabriele Arduino, Andrea Amerio, Alessandra Costanza, Gianluca Serafini and Mario Amore

Volume 22, Issue 2, 2023

Published on: 29 April, 2022

Page: [313 - 316] Pages: 4

DOI: 10.2174/1871527321666220324121207

Price: $65


Background: Clozapine may be considered the first-line option for treatment-resistant schizophrenia (TRS), a condition that occurs in more than 30% of patients with schizophrenia. Despite its efficacy for treating TRS, clozapine use is limited by the occurrence of several adverse effects in more than 70% of cases. Clozapine does not typically affect lung function, although a few cases have been reported in the literature.

Case Presentation: To gain a better understanding of this rare event, here we report the case study of a young female with TRS, who was treated with clozapine and developed medium and bilateral pleural effusion relief with contiguous atelectasis and polyserositis. Two weeks after stopping clozapine, the follow-up chest scan showed complete remission of the pulmonary condition. We postulate that clozapine might have caused, in this case, a specific immunoinflammatory response leading to serosal complications.

Conclusion: Although the underlying mechanisms of this adverse effect are not completely understood, early manifestations, such as benign eosinophilia, fever, and flu-like symptoms need to be considered a potential warning to facilitate an early diagnosis and carefully manage pulmonary complications related to clozapine treatment.

Keywords: Schizophrenia, serositis, clozapine, side effects, case report, Treatment-Resistant Schizophrenia (TRS).

« Previous
Remington G, Addington D, Honer W, Ismail Z, Raedler T, Teehan M. Guidelines for the pharmacotherapy of schizophrenia in adults. Can J Psychiatry 2017; 62(9): 604-16.
[] [PMID: 28703015]
De Fazio P, Gaetano R, Caroleo M, et al. Rare and very rare adverse effects of clozapine. Neuropsychiatr Dis Treat 2015; 11: 1995-2003.
[] [PMID: 26273202]
Warnez S, Alessi-Severini S. Clozapine: A review of clinical practice guidelines and prescribing trends. BMC Psychiatry 2014; 14(1): 102.
[] [PMID: 24708834]
Verdoux H, Quiles C, de Leon J. Clinical determinants of fever in clozapine users and implications for treatment management: A narrative review. Schizophr Res 2019; 211: 1-9.
[] [PMID: 31378552]
de Leon J, Ruan CJ, Schoretsanitis G, De Las Cuevas C. A rational use of clozapine based on adverse drug reactions, pharmacokinetics, and clinical pharmacopsychology. Psychother Psychosom 2020; 89(4): 200-14.
[] [PMID: 32289791]
Daly JM, Goldberg RJ, Braman SS. Polyserositis associated with clozapine treatment. Am J Psychiatry 1992; 149(9): 1274-5.
[] [PMID: 1503144]
Burns AV, Halpin LE, Rosseel SLS. J Allergic to clozapine: A case of clozapine-associated eosinophilia with pleural effusions followed by pancreatitis on clozapine rechallenge. Clin Psychopharmacol 2020; 40(2): 199-200.
[] [PMID: 32134858]
Demelo-Rodríguez P, de Miguel-Yanes JM, Gómez-Vallejo S. Clozapine-induced eosinophilia and serositis. Rev Psiquiatr Salud Ment 2019; 12(2): 130-1.
[] [PMID: 30808609]
Marchel D, Hart AL, Keefer P, Vredeveld J. Multiorgan eosinophilic infiltration after initiation of clozapine therapy: A case report. BMC Res Notes 2017; 10(1): 316.
[] [PMID: 28743303]
Hashimoto N, Maeda T, Okubo R, Narita H, Kusumi I. Simple pulmonary eosinophilia associated with clozapine treatment. J Clin Psychopharmacol 2015; 35(1): 99-101.
[] [PMID: 25514065]
Kang SH, Lee JI. Eosinophilia, pleural effusion, hepatitis, and jaundice occurring early in clozapine treatment. Clin Psychopharmacol Neurosci 2013; 11(2): 103-5.
[] [PMID: 24023555]
Bugge E, Nissen T, Wynn R. Probable clozapine-induced parenchymal lung disease and perimyocarditis: A case report. BMC Psychiatry 2016; 16(1): 438.
[] [PMID: 27931201]
Can KC, Karnak D, Özgüven HD. A very rare adverse effect of clozapine, clozapine-induced interstitial lung disease: Case report and literature review. Noro Psikiyatri Arsivi 2019; 56(4): 313-5.
[] [PMID: 31903043]
Mouaffak F, Gaillard R, Burgess E, Zaki H, Olié JP, Krebs MO. Clozapine-induced serositis: Review of its clinical features, pathophysiology and management strategies. Clin Neuropharmacol 2009; 32(4): 219-23.
[] [PMID: 19620851]
Gallagher RM, Kirkham JJ, Mason JR, et al. Development and inter-rater reliability of the Liverpool adverse drug reaction causality assessment tool. PLoS One 2011; 6(12): e28096.
[] [PMID: 22194808]
Jang SJ, Yi HT, Paek JH, Lee SY. Clozapine-induced acute hepatitis. J Korean Neuropsychiatr Assoc 1999; 38: 227-33.
Pollmächer T, Haack M, Schuld A, Kraus T, Hinze-Selch D. Effects of antipsychotic drugs on cytokine networks. J Psychiatr Res 2000; 34(6): 369-82.
[] [PMID: 11165304]
Raja M, Raja S. Clozapine safety, 40 years later. Curr Drug Saf 2014; 9(3): 163-95.
[] [PMID: 24809463]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy