Chlorpromazine-induced lupus with cardiac tamponade

Although the association of the phenothiazines with immunologic abnormalities is well known, reports of clinical lupus erythematosus are rare. We describe a 52-year old schizophrenic man on chronic chlorpromazine therapy who developed fever and pleuropericarditis with cardiac tamponade. Examination of the pleural and pericardial fluids showed anti-nuclear antibodies. The clinical syndrome responded to a short course of steroids and discontinuation of the chlorpromazine. Drug-induced lupus is a self-limited illness that resolves without long-term sequelae. However, patients should be observed carefully because cardiac tamponade may occur.