A Case of Clozapine-Induced Myocarditis in a Young Patient with Bipolar Disorder

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 sho...

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Main Authors:	Cohen, Ronny, Lysenko, Alla, Mallet, Thierry, Mirrer, Brooks, Gale, Michael, Loarte, Pablo, McCue, Robert
Format:	Online
Language:	English
Published:	Hindawi Publishing Corporation 2015
Online Access:	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4568044/

id	pubmed-4568044
recordtype	oai_dc
spelling	pubmed-45680442015-09-27 A Case of Clozapine-Induced Myocarditis in a Young Patient with Bipolar Disorder Cohen, Ronny Lysenko, Alla Mallet, Thierry Mirrer, Brooks Gale, Michael Loarte, Pablo McCue, Robert Case Report 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. Hindawi Publishing Corporation 2015 2015-08-30 /pmc/articles/PMC4568044/ /pubmed/26413355 http://dx.doi.org/10.1155/2015/283156 Text en Copyright © 2015 Ronny Cohen et al. https://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
repository_type	Open Access Journal
institution_category	Foreign Institution
institution	US National Center for Biotechnology Information
building	NCBI PubMed
collection	Online Access
language	English
format	Online
author	Cohen, Ronny Lysenko, Alla Mallet, Thierry Mirrer, Brooks Gale, Michael Loarte, Pablo McCue, Robert
spellingShingle	Cohen, Ronny Lysenko, Alla Mallet, Thierry Mirrer, Brooks Gale, Michael Loarte, Pablo McCue, Robert A Case of Clozapine-Induced Myocarditis in a Young Patient with Bipolar Disorder
author_facet	Cohen, Ronny Lysenko, Alla Mallet, Thierry Mirrer, Brooks Gale, Michael Loarte, Pablo McCue, Robert
author_sort	Cohen, Ronny
title	A Case of Clozapine-Induced Myocarditis in a Young Patient with Bipolar Disorder
title_short	A Case of Clozapine-Induced Myocarditis in a Young Patient with Bipolar Disorder
title_full	A Case of Clozapine-Induced Myocarditis in a Young Patient with Bipolar Disorder
title_fullStr	A Case of Clozapine-Induced Myocarditis in a Young Patient with Bipolar Disorder
title_full_unstemmed	A Case of Clozapine-Induced Myocarditis in a Young Patient with Bipolar Disorder
title_sort	case of clozapine-induced myocarditis in a young patient with bipolar disorder
description	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.
publisher	Hindawi Publishing Corporation
publishDate	2015
url	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4568044/
_version_	1613475199330549760

A Case of Clozapine-Induced Myocarditis in a Young Patient with Bipolar Disorder

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