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Clozapine-induced peripheral and pleural fluid eosinophilia
Jayshil J Patel1, Paul A Lisi, Zubin Lathara
1Division of Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, USA. japatel@mcw.edu
The Annals of Pharmacotherapy
|January 26, 2012
Summary
Clozapine, an antipsychotic, can cause a rare condition of peripheral and pleural fluid eosinophilia (PFE). This case report details a patient who recovered after discontinuing clozapine, highlighting it as a potential cause of PFE.
Area of Science:
- Internal Medicine
- Psychiatry
- Pulmonology
Background:
- Clozapine is an atypical antipsychotic used for treatment-resistant schizophrenia and bipolar disorder.
- Adverse effects of clozapine include tachycardia, somnolence, weight gain, and sialorrhea.
- Rarely, clozapine can cause serious adverse reactions like pancreatitis and agranulocytosis.
Observation:
- A 28-year-old male patient on clozapine for bipolar disorder presented with dyspnea.
- Physical examination revealed a large right-sided pleural effusion.
- Peripheral blood and pleural fluid analysis showed significant eosinophilia.
Findings:
- Extensive investigations excluded other causes of peripheral and pleural fluid eosinophilia (PFE).
- A causality assessment indicated clozapine as the probable cause of the patient's PFE.
- Discontinuation of clozapine led to complete resolution of symptoms, eosinophilia, and pleural effusion.
Implications:
- Drug-induced pleural disease is uncommon, with only a few drugs implicated in PFE.
- This is the first reported case of clozapine-induced peripheral eosinophilia and PFE.
- Clinicians should consider clozapine as a potential cause in patients presenting with PFE.
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