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Case Report
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| Managing clozapine-induced neutropenic fever: A case report | ||||||
| Regis G. Rosa1, Maria D. Rosa2, Alcina J. S. Barros2 | ||||||
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1MD, PhD, Intensive Care Unit at the Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil.
2MD,Intensive Care Unit at the Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil. | ||||||
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| How to cite this article |
| Rosa RG, Rosa MD, Barros AJS. Managing clozapine-induced neutropenic fever: A case report. Int J Case Rep Images 2015;6(5):301–304. |
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Abstract
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Introduction:
Clozapine is an atypical antipsychotic, which is associated with an increased risk of neutropenia. Given that the signs and symptoms of infection in neutropenic patients are often subtle or absent because of the lack of an appropriate inflammatory response, fever may constitute the sole indicator of a serious underlying infection. Unfortunately, data about management of patients with neutropenic fever secondary to clozapine are scarce. Consequently, the entire management of this syndrome is based on extrapolation of data from the experience with cancer patients with neutropenia secondary to cytotoxic chemotherapy.
Case Report: Herein, we describe the management of a neutropenic fever case complicated with septic shock and acute respiratory failure in an 57-year-old Caucasian female with the diagnosis of schizophrenia and type-2 diabetes mellitus, who was being treated with clozapine. The patient rapidly developed cardiorespiratory collapse requiring mechanical ventilation and vasoactive drugs few minutes after arrival at hospital. Profound neutropenia (absolute neutrophil count 60 cells/mm3) and lobar pneumonia were diagnosed. Broad-spectrum antimicrobial therapy with piperacillin-tazobactam plus vancomycin and supportive intensive care were promptly implemented. The clozapine-induced neutropenia was managed with filgrastim. Pseudomonas aeruginosa was isolated from the tracheal aspirate and blood cultures. After a total length of hospital stay of 44 days, the patient was discharged home. Conclusion: Neutropenic fever is a serious complication of clozapine treatment. Prompt administration of empiric broad-spectrum antibiotics and supportive care are required to avoid the high levels of mortality associated with this syndrome. | |
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Keywords:
Clozapine, Critical care, Febrile neutropenia, Neutropenic fever, Septic, Shock
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Author Contributions
Regis G. Rosa – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published Maria D. Rosa – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published Alcina J. S. Barros – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published |
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Guarantor of submission
The corresponding author is the guarantor of submission. |
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Source of support
None |
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Conflict of interest
Authors declare no conflict of interest. |
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Copyright
© 2015 Regis G. Rosaet et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information. |
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