Azithromycin-induced Adolescent Manic Episode with Psychotic Features: A Case Report

Premarketing clinical trials of azithromycin (AZT) computed a 0.8-percent incidence rate of neurological symptoms, such as headaches and vertigo. Postmarket surveillance reported on psychiatric reactions to AZT that included aggression, agitation, anxiety, delirium, and hallucinations. Nonetheless, these observations do not provide further insight on patient characteristics, disease course, and medical intervention.

We report the case of an 18-year-old male patient with no prior medical or psychiatric history who developed profound religious delusions and unusual behavior hours after taking a one-time AZT dose of 1,000mg for a confirmed sexually transmitted Chlamydia trachomatis infection.

The patient presentation and clinical history satisfied criteria for a manic episode with psychotic features lasting for at least one week. As per The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria, the patient was diagnosed with medication-induced manic episode with psychotic features. At presentation, the patient received an intramuscular injection consisting of haloperidol 10mg and diphenhydramine 50mg, followed by olanzapine 10mg, diazepam 20mg, and lorazepam 5mg orally on account of his severe agitation. The patient was then maintained on olanzapine 30mg and lorazepam 5mg for six days. Lorazepam was then titrated down to 4mg for two days, then to 3mg in the outpatient setting. The patient demonstrated relative improvement in both the inpatient and outpatient settings, with no relapse despite eventual discontinuation of psychotropic medication.

We report, to our knowledge for the first time, that AZT monotherapy might induce a manic episode with psychotic features in adolescent patients with no psychiatric medical history.