Clozapine-associated pneumonia and respiratory arrest secondary to severe constipation.
Clozapine is often the drug of choice within patients suffering from treatment-resistant paranoid schizophrenia. It has a complex side effects profile which includes potentially fatal agranulocytosis. Clozapine has also become increasingly associated with a range of other side effects including constipation and pneumonia. We report on a case of clozapine-induced severe constipation leading to a silent presentation of pneumonia with a subsequent respiratory arrest. To our knowledge, this is the first case report of pneumonia secondary to severe constipation occurring in the absence of respiratory aspiration of feculent vomitus. We suggest a new pathological mechanism by way of severe constipation leading to diaphragmatic dysfunction and subsequent clozapine-induced pneumonia. In addition, implications for clinical practice are outlined.
St Andrew's Healthcare, Birmingham, UK.
Nuwan
N
Galappathie
Sobia
S
Khan
D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects*; D003024:Clozapine / Q000009:adverse effects*; D003248:Constipation / Q000139:chemically induced* / Q000150:complications; D005244:Fecal Impaction / Q000150:complications; D006801:Humans; D008297:Male; D011014:Pneumonia / Q000209:etiology*; D012131:Respiratory Insufficiency / Q000209:etiology*; D012563:Schizophrenia, Paranoid / Q000188:drug therapy; D012812:Sigmoidoscopy
D014150:Antipsychotic Agents; D003024:Clozapine
clozapine; constipation; pneumonia; respiratory arrest; schizophrenia