Abstract
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/mm³. 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.
Highlights
Clozapine is the antipsychotic of choice in the treatment of refractory schizophrenia
Various cohort studies indicate that 20%-30% of patients with schizophrenia meet criteria for refractory schizophrenia[1]
Clozapine is associated with various haematological adverse effects, including leukopenia, neutropenia, agranulocytosis, leukocytosis, anaemia, eosinophilia, thrombocytopenia and thrombocytosis
Summary
Various cohort studies indicate that 20%-30% of patients with schizophrenia meet criteria for refractory schizophrenia[1]. By the fourth week after clozapine was started, the patient was taking 200 mg per day and her eosinophils count began to increase. Since the gastrointestinal symptoms continued despite it all, they were attributed to clozapine and it was decided to stop titration and maintain the patient under close observation. She was receiving 300 mg/day of clozapine. Considering symptoms’ severity and the lack of response to other antipsycho tics, we decided not to withdraw clozapine and maintain the dose she was taking at the moment: 300 mg/d Colonoscopy and endoscopy, both with biopsy, were performed to look for eosinophilic infiltrate. 0 0 1 3 6 8 12 15 18 21 28 32 35 40 43 46 49 54 60 64 70 79 Days in use of clozapine
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