LACTIC-ACIDOSIS AND FATAL MYOCARDIAL FAILURE DUE TO CLOZAPINE

OBJECTIVE: TO describe a patient with neutropenic fever complicated by hyperglycemia, lactic acidosis, and fatal myocardial failure associat ed with clozapine therapy. CASE SUMMARY: A 37-year-old Ashkenazic Jewi sh man was admitted for agranulocytosis and fever, which developed aft er 11 weeks of clozapine monotherapy for drug-resistant schizophrenia Complete blood counts and a routine serum chemical analysis had been n ormal before the treatment was initiated, and remained within normal l imits during the first 10 weeks of the treatment On the day of admissi on, the patient deteriorated rapidly and developed extreme hyperglycem ia severe lactic acidosis, recurrent cardiac arrest, cardiogenic shock , and coma He died 36 hours later despite intensive treatment. DISCUSS ION: Clozapine intake induced fatal aganulocytosis, associated with hy perglycemia, lactic acidosis, and heart failure. White blood cell coun t monitoring was insufficient to predict these adverse effects. CONCLU SIONS: Clozapine should be avoided in high-risk patients (e.g., the el derly, women, Ashkenazic Jews).