title: C-reactive protein: an early critical sign of clozapine-related myocarditis.
abstract: OBJECTIVE
  We present a case of clozapine-related myocarditis, with a rising C-reactive protein as the only initial evidence supporting the diagnosis.
  
  
  METHODS
  An otherwise healthy young male presenting with treatment-resistant schizophrenia was started on clozapine. Monitoring was performed.
  
  
  RESULTS
  At day 18 he developed fever, tachycardia and a raised C-reactive protein, while troponin levels and echocardiogram remained normal.
  
  
  CONCLUSIONS
  Current protocols monitoring for myocarditis have their limitations and can often only be used to support a presumptive diagnosis of myocarditis. In keeping with the current clozapine monitoring guidelines, we demonstrate that a rise in C-reactive protein levels can be a critical early sign of myocarditis warranting close monitoring and serious consideration for cessation of clozapine.
authors.affiliation: Resident Medical Officer, Department of Psychiatry, Alfred Health, Melbourne, VIC, Australia S.Fehily@alfred.org.au.
authors.forename: Sasha R
authors.initials: SR
authors.lastname: Fehily
authors.affiliation: Consultant Psychiatrist, Department of Psychiatry, Alfred Health, Melbourne, VIC, Australia.
authors.forename: Rosaria
authors.initials: R
authors.lastname: Forlano
authors.affiliation: Consultant Psychiatrist, Professor of Psychiatry and Deputy Director, Department of Psychiatry, Alfred Health, Melbourne, VIC, and; Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, Melbourne, VIC, Australia.
authors.forename: Paul B
authors.initials: PB
authors.lastname: Fitzgerald
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects*; D002097:C-Reactive Protein / Q000378:metabolism*; D003024:Clozapine / Q000009:adverse effects*; D042241:Early Diagnosis; D006801:Humans; D008297:Male; D009205:Myocarditis / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis*; D013997:Time Factors; D014336:Troponin / Q000097:blood
chemical_list: D014150:Antipsychotic Agents; D014336:Troponin; D002097:C-Reactive Protein; D003024:Clozapine
keywords: C-reactive protein; cardiac magnetic resonance imaging; clozapine; myocarditis