The development of a clinical syndrome of asymptomatic pancreatitis and eosinophilia after treatment with clozapine in schizophrenia: implications for clinical care, recognition and management

Garlipp, Petra; Rosenthal, O.; Haltenhof, Horst; Machleidt, Wielant

doi:10.1177/026988110201600419

Cited by 24 publications

(9 citation statements)

References 6 publications

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“…Differently from the cases reported by Bergemann et al [11], Garlipp et al [10], and Sani et al [5], our patient was symptomatic, as the other eleven cases reported in the literature.…”

Section: Discussioncontrasting

confidence: 92%

“…Differently from Frankenburg and Kando [8], Chengappa et al [9] and Garlipp et al [10], we did not observe eosinophilia, but this abnormality is by no means the rule with clozapine-associated pancreatitis. Differently from the cases reported by Bergemann et al [11], Garlipp et al [10], and Sani et al [5], our patient was symptomatic, as the other eleven cases reported in the literature.…”

Section: Discussioncontrasting

confidence: 90%

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A Case of Clozapine-Associated Pancreatitis

Raja¹,

Azzoni²

2011

TONEUROPPJ

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Acute pancreatitis is a very rare complication of clozapine treatment. We report a new case of symptomatic pancreatitis subsequent to starting of clozapine treatment. In this case, the diagnosis of pancreatitis can be considered definitive and the etiological link between clozapine and pancreatitis highly likely. Recovery was not complete. In a 10-year period, we treated 363 cases (196 patients) with clozapine. We diagnosed clozapine-associated pancreatitis only in this patient. However, we did not check amylase and lipase plasma levels in all patients and possibly missed several cases of pancreatitis. We suggest monitoring pancreatic enzymes routinely, at least in the first months of clozapine therapy.

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“…Differently from the cases reported by Bergemann et al [11], Garlipp et al [10], and Sani et al [5], our patient was symptomatic, as the other eleven cases reported in the literature.…”

Section: Discussioncontrasting

confidence: 92%

Section: Discussioncontrasting

confidence: 90%

A Case of Clozapine-Associated Pancreatitis

Raja¹,

Azzoni²

2011

TONEUROPPJ

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“…This hematological side effect has been found in 0,2 to 61,7% of clozapine-treated patients 2,[4][5][6][7][8][9]15 . The high variability of the reported rates can be attributed to four factors: small samples sizes, differences in patient pools, varied trial lengths and inconsistencies in the definition of this dyscrasia 8 .…”

Section: Discussionmentioning

confidence: 99%

“…In those cases, clozapine's withdrawal was mandatory due to the eosinophilia's life threatening consequences 6,9,12,13,16 . Nevertheless, the possibility of its reintroduction exists even in such cases provided that a close clinical monitoring is mantained 13 .…”

Section: Case Reportmentioning

confidence: 99%

Clozapine-induced severe eosinophilia: report of a case with good outcome

Marcelino

Dantas²

2013

J. bras. psiquiatr.

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Introduction: Clozapine is the antipsychotic of choice in the treatment of refractory schizophrenia. However, its side effects, such as eosinophilia, may preclude its use. Methods: Case report and literature review. results: Young woman, 19 years old, diagnosed with hebefrenic schizophrenia, admitted at Unicamp's psychiatry ward after psychotic symptoms relapse. Clozapine was started after unsuccessful attempts with risperidon and olanzapine. By the fourth week of clozapine use, eosinophils began to increase. Drug titration was stopped, but eosinophils counts continued to rise up, reaching the mark of 5200/mm 3 . Due to severity of psychotic symptoms and to the good response obtained with clozapine, we decided to investigate organs involvement before withdrawing the medication. As the patient had no organs involvement, clozapine was maintained and one month after eosinophils peak, it was already normalized. Conclusion: Eosinophilia should not necessarily lead to clozapine's withdrawal. Patients who present eosinophilia must be at rigorous observation for organs involvement, and if there is no such involvement, clozapine might be maintained, considering the possible benign and transitory nature of the eosinophils count elevation.

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“…Clozapine-associated eosinophilia has been reported in two different forms: transient benign eosinophilia and eosinophilia with end organ damage [1–3]. Clozapine-associated eosinophilia with end organ damage has reportedly been associated with pancreatitis [4], pleural effusions [5], eosinophilic pneumonia [6], colitis [7], hepatitis [8], and pericarditis [9]. Here we describe a patient with a dramatic eosinophilic response to clozapine resulting in systemic manifestations.…”

Section: Introductionmentioning

confidence: 99%

Multiorgan eosinophilic infiltration after initiation of clozapine therapy: a case report

Marchel¹,

Hart²,

Keefer³

et al. 2017

BMC Res Notes

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BackgroundThe eosinophilic response to clozapine is well described in the literature, causing a variety of responses, from serositis to colitis. However, there are not case reports describing a clozapine-induced marked eosinophilia resulting in multiorgan dysfunction.Case presentationIn this case report, we describe a 24 year old Caucasian male who presented with severe systemic eosinophilia resulting in eosinophilic GI tract infiltration, myocarditis, pericardial and pleural effusions with dramatic improvement following drug withdrawal.ConclusionsClozapine associated eosinophilia should be suspected in the setting of eosinophilic infiltration of multiple organs.

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The development of a clinical syndrome of asymptomatic pancreatitis and eosinophilia after treatment with clozapine in schizophrenia: implications for clinical care, recognition and management

Cited by 24 publications

References 6 publications

A Case of Clozapine-Associated Pancreatitis

A Case of Clozapine-Associated Pancreatitis

Clozapine-induced severe eosinophilia: report of a case with good outcome

Multiorgan eosinophilic infiltration after initiation of clozapine therapy: a case report

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