Late-onset clozapine-induced agranulocytosis in a patient with comorbid multiple sclerosis.
The risk of clozapine-induced agranulocytosis is highest in the initial 6 months after onset of treatment. There have been very few reports of neutropenia and agranulocytosis after this period. We report a unique case of delayed clozapine-induced agranulocytosis in a patient with preexisting multiple sclerosis (MS) which was treated with granulocyte colony-stimulating factor. Both MS and clozapine-induced agranulocytosis have an underlying autoimmune immune mechanism. This case highlights the need for frequent blood count monitoring on clozapine even after the initial 6 months of starting treatment especially in patients with a past history of drop in white blood cell counts as well as with a comorbid autoimmune disorder.
Department of Psychiatry, National Institute of Mental Health And Neurosciences (NIMHANS), Bangalore-560029, India. Electronic address: dhanya.ravi@gmail.com.
Dhanya
D
Raveendranathan
Eesha
E
Sharma
Ganesan
G
Venkatasubramanian
Mukund G
MG
Rao
Shivarama
S
Varambally
Bangalore N
BN
Gangadhar
D000328:Adult; D000380:Agranulocytosis / Q000139:chemically induced*; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D003024:Clozapine / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D009103:Multiple Sclerosis / Q000150:complications*; D012563:Schizophrenia, Paranoid / Q000150:complications / Q000188:drug therapy
D014150:Antipsychotic Agents; D003024:Clozapine