title: Clozapine Associated with Autoimmune Reaction, Fever and Low Level Cardiotoxicity - A Case Report.
abstract: Clozapine is a second-generation antipsychotic drug used in treatment-resistant schizophrenia. Fever induced by clozapine is a rather frequent side-effect which usually occurs in the first 4 weeks of treatment. Despite its effectiveness, there are potentially life-threatening adverse effects, such as cardiotoxicity.
  
  
  
  We present the case of a 31-year-old caucasian male with refractory schizophrenia who developed benign fever, increase of C-reactive protein and high troponin levels, without presenting any other signs to myocarditis, on the 13th day under clozapine treatment, which declined progressively upon discontinuation of the drug.
  
  
  
  This case hints at the presence of initially subclinical cardiotoxicity as an underlying factor in patients developing fever.
  
  
  
  Taking advantage of more sensitive methods for measuring troponin, clinicians would be promptly aware of this possible side-effect. This would allow for significant reduction of the risk of cardiac dysfunction, further attained by carefully monitoring the patient.
authors.affiliation: Second Department of Psychiatry, Attikon General Hospital, National & Kapodistrian University of Athens, Medical School, Athens, Greece.
authors.forename: Charilaos
authors.initials: C
authors.lastname: Gerasimou
authors.affiliation: Second Department of Psychiatry, Attikon General Hospital, National & Kapodistrian University of Athens, Medical School, Athens, Greece.
authors.forename: Georgia Phaedra
authors.initials: GP
authors.lastname: Vitali
authors.affiliation: Department of Respiratory Medicine, University of Thessaly, School of Medicine, Larissa, Greece.|Athens Naval Hospital, Neurology Clinic, Athens, Greece.
authors.forename: George D
authors.initials: GD
authors.lastname: Vavougios
authors.affiliation: Laboratory of Hematology and Blood Transfusion Department, Attikon General Hospital, National & Kapodistrian University of Athens, Medical School, Athens, Greece.
authors.forename: Charalabos
authors.initials: C
authors.lastname: Papageorgiou
authors.affiliation: Second Department of Psychiatry, Attikon General Hospital, National & Kapodistrian University of Athens, Medical School, Athens, Greece.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Douzenis
authors.affiliation: Laboratory of Hematology and Blood Transfusion Department, Attikon General Hospital, National & Kapodistrian University of Athens, Medical School, Athens, Greece.
authors.forename: Styliani I
authors.initials: SI
authors.lastname: Kokoris
authors.affiliation: First Department of Psychiatry, Eginition Psychiatric Hospital, National & Kapodistrian University of Athens, Medical School, Athens, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Liappas
authors.affiliation: Second Department of Psychiatry, Attikon General Hospital, National & Kapodistrian University of Athens, Medical School, Athens, Greece erizos@med.uoa.gr.
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Rizos
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects*; D015551:Autoimmunity / Q000187:drug effects*; D066126:Cardiotoxicity / Q000209:etiology*; D003024:Clozapine / Q000009:adverse effects*; D004562:Electrocardiography; D005334:Fever / Q000139:chemically induced*; D006801:Humans; D008297:Male; D012559:Schizophrenia / Q000188:drug therapy*
chemical_list: D014150:Antipsychotic Agents; D003024:Clozapine
keywords: Cardiotoxicity; case report; clozapine; fever; schizophrenia