clozapine and Pleural-Effusion

Drug-induced pleural disease is uncommon and less known to clinicians than drug-induced parenchymal lung disease. Pleural reactions from drugs manifest as pleural effusions, pleural thickening, or pleuritic chest pain, and may occur in the absence of parenchymal infiltrates. The clinician should be cognizant of the possibility of a drug-induced pleural reaction. A detailed drug history, temporal relationship between symptom onset and initiation of therapy, and pleural fluid eosinophilia should raise the suspicion of a drug-related process. We suspect that as new drugs are marketed in the United States, the number of drugs that result in pleuropulmonary toxicity will continue to increase. Moreover, if the cause of an exudative pleural effusion is not clinically obvious after pleural fluid analysis, drug therapy withdrawal should be a consideration if clinically appropriate before initiating an extensive diagnostic evaluation that may entail unnecessary economic burden and discomfort for the patient.

Topics: Anti-Infective Agents, Urinary; Antimetabolites, Antineoplastic; Bleomycin; Cardiovascular Agents; Clozapine; Cyclophosphamide; Eosinophilia; Humans; Immunosuppressive Agents; Interleukin-2; Methotrexate; Methysergide; Nitrofurantoin; Penicillamine; Pleural Diseases; Pleural Effusion; Serotonin Antagonists

Increasing reports have appeared of pleural effusion and peripheral eosinophilia associated with clozapine treatment. These reports describe the onset of pleural effusion from 2 to 5 weeks after initiation of clozapine. Here, we describe a case of a 28-year-old Chinese male who presented with pleural effusion and peripheral eosinophilia ∼17 weeks after initiation of clozapine. We discuss this delayed presentation and examine the potential significance of the patient's East Asian ethnicity. We recommend clinicians consider ethnicity and other factors that can affect the metabolism of clozapine when choosing a clozapine titration schedule and when monitoring during clozapine treatment.

Topics: Adult; China; Clozapine; Eosinophilia; Humans; Male; Pleural Effusion

Topics: Adult; Clozapine; Humans; Male; Pleural Effusion

Topics: Antimanic Agents; Antipsychotic Agents; Clozapine; Drug Therapy, Combination; Eosinophilia; Female; Humans; Middle Aged; Pleural Effusion; Valproic Acid

Topics: Adult; Anticonvulsants; Antipsychotic Agents; Cardiac Tamponade; Clozapine; Drug Eruptions; Drug Therapy, Combination; Female; Humans; Pericardial Effusion; Pericarditis; Pleural Effusion; Schizophrenia; Serositis; Valproic Acid

Topics: Adult; Antipsychotic Agents; Clozapine; Humans; Male; Pericardial Effusion; Pleural Effusion; Schizophrenia, Paranoid

Topics: Acute Disease; Aged; Antipsychotic Agents; Clozapine; Humans; Male; Pericardial Effusion; Pleural Effusion; Psychotic Disorders; Serositis

Topics: Adult; Antipsychotic Agents; Chronic Disease; Clozapine; Exanthema; Female; Humans; Pleural Effusion; Schizophrenia, Paranoid; Skin Diseases, Papulosquamous

Topics: Antipsychotic Agents; Clozapine; Drug Hypersensitivity; Exanthema; Fever; Humans; Pleural Effusion

This report describes a 48-year-old caucasian male with schizophrenia who developed hepatitis, hyperglycemia, pleural effusion, eosinophilia, hematuria and proteinuria early in clozapine treatment which resolved on drug discontinuation. The literature on similar cases is reviewed.

Topics: Antipsychotic Agents; Blood Cell Count; Chemical and Drug Induced Liver Injury; Clozapine; Eosinophilia; Hematuria; Humans; Hyperglycemia; Male; Middle Aged; Pleural Effusion; Proteinuria; Schizophrenia, Paranoid; Tomography, X-Ray Computed

Topics: Adult; Antipsychotic Agents; Cellulitis; Clozapine; Eosinophilia; Humans; Male; Pleural Effusion; Psychotic Disorders

Topics: Adult; Clozapine; Female; Humans; Pericardial Effusion; Pleural Effusion; Schizophrenia