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Pleural effusion associated with clozapine treatment
Margarita Grneva1, Milica Pjevac2,3, Karla Prebil2
1Neurology Unit, General Hospital Slovenj Gradec, Slovenj Gradec, Slovenia.
BMJ Case Reports
|August 13, 2026
Summary
Clozapine, an antipsychotic for treatment-resistant schizophrenia, can cause rare side effects like eosinophilia and pleural effusion. Discontinuing clozapine led to full recovery in a patient, highlighting the need for vigilance.
Area of Science:
- Pharmacology
- Pulmonology
- Psychiatry
Background:
- Clozapine is a vital antipsychotic for treatment-resistant schizophrenia (TRS).
- Adverse effects of clozapine necessitate careful patient monitoring.
- Distinguishing somatic symptoms from negative symptoms in schizophrenia is challenging.
Purpose of the Study:
- To report a rare case of clozapine-induced eosinophilia and bilateral pleural effusion.
- To emphasize the importance of considering drug-induced adverse reactions in schizophrenia management.
- To highlight the potential for full recovery upon early recognition and intervention.
Main Methods:
- Case report of a patient in her 60s with treatment-resistant schizophrenia.
- Detailed diagnostic evaluation to exclude other causes of eosinophilia and pleural effusion.
- Monitoring of clinical and radiological parameters after clozapine discontinuation and switch to an alternative antipsychotic.
Main Results:
- The patient developed dose-dependent eosinophilia and bilateral pleural effusion after initiating clozapine.
- Infectious, cardiac, and thromboembolic causes were ruled out.
- Discontinuation of clozapine resulted in complete resolution of pleural effusions and normalization of eosinophil counts.
Conclusions:
- This case suggests a probable clozapine-related adverse reaction.
- Early recognition and prompt management, including clozapine discontinuation, are crucial for patient recovery.
- Physicians should consider somatic causes, even rare drug reactions, in patients with schizophrenia presenting with unexplained symptoms.
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