A Case of Drug-Induced Interstitial Pneumonia Potentially Related to Quetiapine (Seroquel) Therapy for Behavioral and Psychological Symptoms

Abstract

Quetiapine is regarded as an effective and safe treatment for delirium. An 82-year-old man presented with a 1-week history of violent behavior and dizziness accompanied by weakness on the left side of his body. He was diagnosed with acute cerebral cortical infarction and delirium associated with alcohol abuse. After quetiapine treatment, he complained of fever and coughed up sputum, whereas his aggressive behavior improved. His symptoms persisted despite empirical antibiotic treatment. All diagnostic tests for infectious causes were negative. High-resolution computed tomography revealed bilateral consolidations and ground-glass opacities with predominantly peribronchial and subpleural distributions. The primary differential diagnosis was drug-associated interstitial lung disease, and therefore, we discontinued quetiapine and began methylprednisolone treatment. His symptoms and radiologic findings significantly improved after receiving steroid therapy. We propose that clinicians need to be aware of the possibility that quetiapine is associated with lung injury. Key words: quetiapine; alcohol abuse; interstitial pneumonia. [Respir Care 2014;59(10):e145-e148.

Biological substantiation of antipsychotic-associated pneumonia: Systematic literature review and computational analyses

“…Ten studies were reviews/meta-analyses [ 1 , 13 , 18 , 27 , 41 – 46 ], while other studies included 12 case reports [ 47 – 58 ]and one letter to the editor[ 15 ]. Most of the literature concerned patients aged 65 and older [ 1 , 4 , 6 , 8 – 10 , 12 , 18 , 35 , 38 , 41 , 45 , 47 , 49 , 51 ] while others investigated an adult population with bipolar/schizophrenic disorders [ 26 , 36 , 37 , 40 , 48 , 50 , 55 , 56 , 59 ]. No randomized clinical trials (RCTs) were identified, but one meta-analysis of 6 RTCs was found [ 27 ]( S2 Fig ).…”

“…The clinical events triggered by APs binding to their targets and leading to pneumonia are summarized in Table 1 .These include dry mouth and impaired peristalsis due to muscarinic M1 receptor blockade, as well as sedation with subsequent impaired swallowing due to histamine H1 receptor blockade. Lesser known mechanisms proposed involved the immune system [ 6 , 10 , 26 , 36 , 41 , 43 ], cytochrome metabolism system [ 47 ], inflammatory pathways [ 15 , 41 ], an eotaxin (i.e., a chemoattractant for eosinophils) and serotonin eosinophilic-specific chemo-attracting action leading to eosinophilic pneumonia [ 49 ].…”

A Fatal Case of Drug-Induced Lung Injury Potentially Related to Olanzapine

“…The absence of prior reports leading to a fatal outcome highlights the importance of recognizing the potential adverse effects of olanzapine. While the literature has documented pulmonary complications associated with the same class of medication, quetiapine, our case suggests a need for increased vigilance regarding olanzapine use as well [9].…”

Quetiapine-related acute lung injury: A case report

“…In a systematic review, the data suggested that common adverse reactions to quetiapine included somnolence (25%-39%), dizziness (15%-27%), headache (10%-23%), postural hypotension (6%-18%), and weight gain (11%-30%)[ 4 ]. Additionally, quetiapine treatment can increase the risk of pneumonia among patients with schizophrenia[ 5 ], which has been confirmed in a case of quetiapine-induced interstitial pneumonia[ 6 ].…”