title: A Case of Clozapine-Induced Myocarditis in a Young Patient with Bipolar Disorder.
abstract: We present a case of drug-induced myocarditis manifesting as acute heart failure in a young patient with bipolar disorder being treated for depression. The case describes a 20-year-old man being treated in the psychiatry ward for worsening depression when he started complaining of chest pain and shortness of breath. His list of medications included clozapine, lithium, lorazepam, and haloperidol. The main findings on physical examination were tachycardia, low-grade fever, crackles in both lung bases on auscultation, and the absence of any notable edema. Abnormal labs included a troponin of 0.9, with a CK of 245 and CK-MB of 3.1. An ECG revealed sinus tachycardia and left anterior fascicular block (LAFB). An echocardiogram revealed global hypokinesis, severe left ventricular dysfunction with an ejection fraction estimated at 20%. The patient had an admitting diagnosis of acute left ventricular systolic dysfunction likely secondary to drug-induced myocarditis (suspect clozapine) versus acute coronary syndrome. He was managed conservatively and transferred to another facility for endomyocardial biopsy confirming myocarditis. This case is an example of one of the most typical presentations of suspected drug-induced acute myocarditis and will hopefully prompt the reader to think of this underdiagnosed entity in the right clinical setting.
authors.affiliation: Chief of Cardiology, Woodhull Medical Center, 760 Broadway, Brooklyn, NY 11206, USA.
authors.forename: Ronny
authors.initials: R
authors.lastname: Cohen
authors.affiliation: Pharmacy Department, Woodhull Medical Center, 760 Broadway, Brooklyn, NY 11206, USA.
authors.forename: Alla
authors.initials: A
authors.lastname: Lysenko
authors.affiliation: Department of Medicine, Woodhull Medical Center, 760 Broadway, Brooklyn, NY 11206, USA.
authors.forename: Thierry
authors.initials: T
authors.lastname: Mallet
authors.affiliation: Division of Cardiology, Woodhull Medical Center, 760 Broadway, Brooklyn, NY 11206, USA.
authors.forename: Brooks
authors.initials: B
authors.lastname: Mirrer
authors.affiliation: Department of Medicine, Woodhull Medical Center, 760 Broadway, Brooklyn, NY 11206, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Gale
authors.affiliation: Department of Internal Medicine, Yale-New Haven Hospital, 20 York Street, New Haven, CT 06510, USA.
authors.forename: Pablo
authors.initials: P
authors.lastname: Loarte
authors.affiliation: Woodhull Medical Center, 760 Broadway, Brooklyn, NY 11206, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: McCue