olanzapine and Lupus-Erythematosus--Systemic

Use of electroconvulsive therapy (ECT) has been infrequently described in patients with systemic lupus erythematosus and is most commonly used in patients with catatonia. In this report, we describe the use of ECT in a young adolescent girl who had bipolar affective disorder associated with systemic lupus erythematosus and was treated with ECT for the depressive episode. The patient achieved remission with a course of 6 ECT treatments.

Topics: Adolescent; Alkylating Agents; Anti-Inflammatory Agents; Antidepressive Agents, Second-Generation; Antipsychotic Agents; Benzodiazepines; Bipolar Disorder; Cyclohexanols; Cyclophosphamide; Depressive Disorder, Major; Electroconvulsive Therapy; Female; Humans; Lupus Erythematosus, Systemic; Olanzapine; Prednisolone; Venlafaxine Hydrochloride

In this study, we report the case of a Chinese patient with systemic lupus erythematosus (SLE) who developed neutropenia after treatment by olanzapine for the SLE-related psychiatric symptoms. The relationship between agranulocytosis, SLE and olanzapine is still unknown. Fcγ receptor IIIb (FcγRIIIb) is a low-affinity receptor, constitutively expressed only by neutrophils; NA1 and NA2 have been identified as representing polymorphisms of FcγRIIIb. NA1 is associated with the incidence of autoimmune neutropenia and is particularly frequent in Asiatic ethnic groups. The Chinese patient resulted to be homozygous for NA1. We suggest that the presence of NA1 allele may be a predisposing factor to olanzapine-induced agranulocytosis in patients with SLE. Hence, the analysis of FcγRIIIb polymorphism should be investigated in other cases of antipsychotic-induced agranulocytosis.

Topics: Adult; Antipsychotic Agents; Asian People; Benzodiazepines; Ethnicity; Female; GPI-Linked Proteins; Humans; Lupus Erythematosus, Systemic; Mental Disorders; Neutropenia; Olanzapine; Polymorphism, Genetic; Receptors, IgG