Chlorpromazine-induced Drug Reaction with Eosinophilia and Systemic Symptoms Syndrome

Abstract

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare condition affecting between 1 in 1,000 to 1 in 10,000 patients after exposure to associated drugs. [1] It is a life-threatening condition with a mortality rate of about 10%, which necessitates early identification and treatment. [2] We describe a case of DRESS syndrome secondary to the use of chlorpromazine in a female with paranoid schizophrenia, the diagnostic challenge encountered, and the successful treatment of the condition with corticosteroids. Financial support and sponsorship Nil.

Adverse hematological profiles associated with chlorpromazine antipsychotic treatment in male rats: Preventive and reversal mechanisms of taurine and coenzyme-Q10

“…The regulation of blood within a normal range is crucial for maintaining homeostasis and carrying out its vital functions. In this study, rats treated with CPZ (30 mg/kg/d) for 56 days showed signs of anemia and changes in their blood composition, which are in line with previous studies [32] , [35] , [50] . These changes included alterations in RBC, erythropoietin, WBC, platelet count, PCV, Hb, neutrophil, lymphocyte, and a significant increase in MCV, MCH, and Eos levels.…”

“…The alterations in MCV and MCH, both of which measure the average size of RBCs and the amount of hemoglobin known to transport oxygen in the RBCs respectively, observed in hematological research indicate that CPZ-induced a hemolytic anemic condition linked to RBC disorders [29] , and is in line with previous clinical findings [40] . Chronic life-threatening hematological RBC disorders such as agranulocytosis, have been largely reported in psychotic patients treated with antipsychotic drugs, notably CPZ [32] , [35] , [50] . Although the specific management of anemic-like conditions includes the use of blood transfusion and iron-based supplements, application of naturally occurring compounds with antioxidant functions has increased in recent years owing to the role of oxidative stress in the pathogenesis of hemolytic blood disorders [30] , [72] .…”

“…Reduced WBCs and other related armouries have also been reported to be reduced in the serum after during treatment with antipsychotic drugs such as CPZ [17] , [35] , [50] , suggesting altered immune functions during treatment with these drugs. In line with this, we showed that chronic administration of CPZ to rats causes reduced levels of WBCs relative to control, which is in line with previous studies [35] , [50] . This agrees with the findings of Patrick-Iwuanyanwu et al (2007), who reported that the introduction of an antigen into an organism triggers the production of antibodies in response.…”

“…This agrees with the findings of Patrick-Iwuanyanwu et al (2007), who reported that the introduction of an antigen into an organism triggers the production of antibodies in response. The use of CPZ has been linked to a severe reduction in WBCs and abnormally low platelet count, suggesting the possibility of agranulocytosis, which is a popular life-threatening side effect frequently reported in psychotic patients with schizophrenia [35] , [50] . This is consistent with the results of Muhammad and Oloyede (2009), who observed a decrease in platelet count in animals treated with CPZ as well as the findings of Kumar et al, [46] , as well as Nelson and Cox [64] .…”

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome in a Patient with Bipolar Disorder: A Case Report

“…1,2 Very few reports, however, exist in psychiatric literature. [3][4][5][6] PubMed-based MeSH search [("Drug Hypersensitivity Syndrome"[Majr]) AND "Psychotropic Drugs" [Majr]] and search terms restricted to the title/abstract returned less than 10 case reports, inclusive of cross-reference search.…”