Probable occupational pneumonitis caused by inhalation of crushed clozapine.
We present a case of non-specific interstitial pneumonia (NSIP) probably caused by exposure to  inhaled clozapine powder. The patient worked in a pharmacy and crushed clozapine tablets over  several years. She presented with insidious onset of breathlessness and had mild hypoxia.  High-resolution computed tomography demonstrated centrilobular nodules with peribronchial  consolidation. Lung biopsy revealed a mixed cellular and fibrotic NSIP. Her symptoms and  radiological  findings  resolved once exposure to clozapine powder ceased. The clear temporal relationship  between increased  exposure to inhaled clozapine and the development of NSIP, followed by the  subsequent resolution on cessation of exposure, strongly suggest an occupational cause. Both the active ingredients and the excipients of powdered medicine may be responsible for causing  pneumonitis in chronic exposure.
Department of Respiratory Medicine, University Hospital Llandough, Cardiff, UK. annamaialewis@yahoo.co.uk
A
A
Lewis
A
A
Gibbs
B
B
Hope-Gill
D000280:Administration, Inhalation; D000395:Air Pollutants, Occupational / Q000633:toxicity*; D014150:Antipsychotic Agents / Q000633:toxicity*; D003024:Clozapine / Q000633:toxicity*; D004391:Dust; D005260:Female; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000139:chemically induced* / Q000175:diagnosis; D008875:Middle Aged; D009784:Occupational Diseases / Q000139:chemically induced* / Q000175:diagnosis; D016273:Occupational Exposure / Q000009:adverse effects*; D010604:Pharmacy; D014057:Tomography, X-Ray Computed
D000395:Air Pollutants, Occupational; D014150:Antipsychotic Agents; D004391:Dust; D003024:Clozapine