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Published on: September 24, 2021
Clozapine induced pericarditis: A case report
Christine Sahyouni1, Elika Hefazi1
1VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., Los Angeles, CA 90073, United States.
Abstract:
Clozapine is a second-generation antipsychotic often used for treatment-refractory schizophrenia and has many adverse effects. Cardiac adverse events potentiated by clozapine include myocarditis which is a black box warning. Even more rarely, there are multiple cases of pericarditis reported in the literature. This is a case report of a 32-year old male with paranoid schizophrenia who developed pericarditis after initiation and titration of clozapine in the inpatient psychiatry unit. Patient presented with chest pain, persistent tachycardia, and orthostatic hypotension two weeks after titration of clozapine. The diagnosis of pericarditis was supported by the repeat electrocardiogram which revealed PR depressions, the audible friction rub, and the pleuritic/episodic nature of the chest pain. All other possible causes of pericarditis were ruled out and clozapine was suspected as the most likely explanation. The pericarditis resolved with treatment of colchine and ibuprofen on evidence from a repeat echocardiogram. This case report demonstrates and supports few cases of clozapine induced pericarditis in the literature. Cardiac events of clozapine can be life-threatening; therefore, greater baseline and subsequent cardiac monitoring may be implicated in the future.
Insights
Clozapine, an antipsychotic for schizophrenia, can rarely cause pericarditis. This case highlights a patient who developed pericarditis after clozapine initiation, emphasizing the need for cardiac monitoring.
Area of Science:
- Cardiology
- Psychiatry
- Pharmacology
Background:
- Clozapine is a second-generation antipsychotic used for treatment-refractory schizophrenia.
- Cardiac adverse events, including myocarditis (a black box warning) and pericarditis, are known risks associated with clozapine.
- While rare, clozapine-induced pericarditis necessitates careful consideration due to its potential severity.
Observation:
- A 32-year-old male with paranoid schizophrenia developed pericarditis during clozapine initiation and titration.
- Symptoms included chest pain, persistent tachycardia, and orthostatic hypotension.
- Diagnostic findings included PR depressions on ECG, audible friction rub, and characteristic chest pain nature, with other causes ruled out.
Findings:
- Clozapine was identified as the likely cause of pericarditis in this patient.
- Pericarditis resolved with colchicine and ibuprofen treatment.
- Repeat echocardiogram confirmed resolution of the cardiac event.
Implications:
- This case report adds to the limited literature on clozapine-induced pericarditis.
- It underscores the potential for life-threatening cardiac events with clozapine use.
- Enhanced baseline and ongoing cardiac monitoring may be crucial for patients on clozapine therapy.
