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Clozapine induced pneumonia: A case report of diagnostic difficulties in the time of Covid-19

Published online by Cambridge University Press:  01 September 2022

R. Softic*
Affiliation:
University Clinical Center Tuzla, Of Psychiatry, Tuzla, Bosnia and Herzegovina
A. Tahirovic
Affiliation:
Clinical Centre University of Sarajevo, Psychiatric Clinic, Sarajevo, Bosnia and Herzegovina
G. Sulejmanpasic
Affiliation:
Clinical Centre University of Sarajevo, Psychiatric Clinic, Sarajevo, Bosnia and Herzegovina
A. Memic Serdarevic
Affiliation:
Clinical Centre University of Sarajevo, Psychiatric Clinic, Sarajevo, Bosnia and Herzegovina
A. Cesir
Affiliation:
Clinical Centre University of Sarajevo, Psychiatric Clinic, Sarajevo, Bosnia and Herzegovina
N. Becarevic
Affiliation:
University Clinical Center Tuzla, Of Psychiatry, Tuzla, Bosnia and Herzegovina
*
*Corresponding author.

Abstract

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Introduction

Clozapine is a drug that can cause several side effects. Among the less commonly described is a drug-induced lung disease. Due to its non-specific clinical presentation, it represents a diagnostic challenge. The diagnosis is made based on: 1. Association of exposure to the agent and development of symptoms, 2. Pulmonary infiltration, 3. Exclusion of other causes, 4. Withdrawal of symptoms when the agent is excluded from therapy. To date, there have been only a few descriptions of this condition.

Objectives

Case report of rare side effect of clozapine.

Methods

Case report

Results

Case report: male patient (37) with schizophrenia, was hospitalized after a brutal suicide attempt. The PCR test for COVID-19 that was routinely performed on admission was negative. After the introduction of clozapine into therapy, the patient became febrile. There was a drop in oxygen saturation, a Lung CT scan showed inflammatory changes („ground-glass opacities“), and COVID-19 pneumonia was suspected. Due to the worsening of the mental state, the dose of clozapine was increased. The physical condition further deteriorated: febrile, sO2 declining. After repeated PCR tests for COVID-19 (all negative), interstitial pneumonia caused by clozapine was suspected, and clozapine was excluded from therapy. The physical condition started to improve. Quetiapine was introduced, and occasional episodes of agitation were relieved with intramuscular diazepam. In the following days, the patient’s mental state improved and he was discharged.

Conclusions

Despite its superiority over other antipsychotics, clozapine was with good rationale ranked third in treatment guidelines for schizophrenia.

Disclosure

No significant relationships.

Type
Abstract
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of the European Psychiatric Association
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