[Agranulocytosis in the course of clozapine treatment]

Clozapine is highly effective for drug resistant schizophrenia, it does not cause any extrapiramidal side effects, but involves a high risk of agranulocytosis with fatal outcome. The pathogenesis of agranulocytosis is not clear but genetic factors, as well as immunological and toxic mechanism may play an important role. Since the introduction of the monitoring system of leucocytosis for every patient an increasing number of agranulocytosis cases are being registered. Owing to the monitoring system, an immediate discontinuation of the drug, and the initiation of appropriate treatment the number of cases with fatal outcome is not growing in spite of the increasing number of patients treated with clozapine. In the described patient with chronic schizophrenia and ulcerative disease, agranulocytosis disappeared within 7 days after discontinuation of the drug. Three months later the patient died because of perforation of a duodenal ulcer. A negative influence of closapine on ulcerative disease should by considered, but the authors have not found any information on this topic in the literature.