Gluteal muscle damage and rhabdomyolysis after olanzapine poisoning: a case report

Abstract

Olanzapine is a widely adopted atypical antipsychotic medication used to manage schizophrenia. Reports show that the incidence rate of adverse reactions to olanzapine is significantly lower than those of other classic antipsychotic medications. However, olanzapine overdose may be associated with severe consequences. Herein, we report a 21-year-old female patient who had taken nearly 700 mg (70 tablets) of olanzapine; she was found after 30 hours. As her condition progressed, she presented with rhabdomyolysis, swelling in the thighs and hips, paralytic ileus, digestive tract hemorrhage, and elevated serum amylase and lipase levels; notably, she recovered after treatment. This intractable case is of great clinical significance and suggests that early-phase hemoperfusion plays a critical role in olanzapine poisoning-related rhabdomyolysis.

Delayed-Onset olanzapine-induced rhabdomyolysis

“…Examples of delayed-onset olanzapine-induced rhabdomyolysis have been reported in the literature15 16 but are uncommon. Moreover, cases of olanzapine-induced rhabdomyolysis with creatine kinase peaks above 100 000 U/L are also uncommon even in cases of overdose 7 8 11. Comparing our case with the current literature, we emphasise the importance of recognising that olanzapine-induced rhabdomyolysis can occur with a delayed onset, in the absence of dose changes and overdose, and yet simultaneously be severe in nature.…”

“…The current report presented a case of olanzapine-induced rhabdomyolysis; our case was unique both due to its delayed onset, as well as the severity of rhabdomyolysis with a creatine kinase significantly higher compared with similar case reports 5–15. Of the case reports in the current literature, most involved either commencement of new therapy5 6 12 14 or an intentional overdose 7 8 11.…”

“…Though olanzapine-induced rhabdomyolysis is a rare adverse reaction occurring in fewer than 1 in 10 000 of those taking this medication, this report describes the very real possibility of this side effect and the serious sequelae that can occur, and demonstrates the highest creatine kinase level reported with this medication thus far 5–15…”

“…Less common and more serious complications include extrapyramidal movements, occurring in 0.1% of patients, and rhabdomyolysis, occurring in 0.1%–1.2% of patients 3 4. Previous reports of olanzapine-induced rhabdomyolysis typically describe this occurring soon after the initiation of treatment or in an overdose setting 5–15. Here we describe an unusual case of a person with olanzapine-induced rhabdomyolysis after decades of olanzapine use.…”

Methemoglobinemia and Delayed Encephalopathy After 5-Bromo-2-Nitropyridine Poisoning: A Rare Case Report

“…Palliative care was administered to manage the hemolysis in addition to blood transfusions, if required, and prevent and treat complications. Once hemolysis and rhabdomyolysis have occurred, continuous blood purification treatment can effectively reduce hemoglobin and myohemoglobin in the blood circulation, thus protecting renal function ( 21 ).…”