Galappathie Nuwan, Khan Sobia
St Andrew's Healthcare, Birmingham, UK.
Med Sci Law. 2014 Apr;54(2):105-9. doi: 10.1177/0025802413497708. Epub 2013 Sep 19.
Clozapine is often the drug of choice within patients suffering from treatment-resistant paranoid schizophrenia. It has a complex side effects profile which includes potentially fatal agranulocytosis. Clozapine has also become increasingly associated with a range of other side effects including constipation and pneumonia. We report on a case of clozapine-induced severe constipation leading to a silent presentation of pneumonia with a subsequent respiratory arrest. To our knowledge, this is the first case report of pneumonia secondary to severe constipation occurring in the absence of respiratory aspiration of feculent vomitus. We suggest a new pathological mechanism by way of severe constipation leading to diaphragmatic dysfunction and subsequent clozapine-induced pneumonia. In addition, implications for clinical practice are outlined.
氯氮平通常是治疗难治性偏执型精神分裂症患者的首选药物。它有一系列复杂的副作用，包括可能致命的粒细胞缺乏症。氯氮平还越来越多地与包括便秘和肺炎在内的一系列其他副作用相关联。我们报告了一例氯氮平引起的严重便秘导致隐匿性肺炎并随后呼吸骤停的病例。据我们所知，这是首例在无粪性呕吐物误吸情况下由严重便秘继发肺炎的病例报告。我们提出了一种新的病理机制，即严重便秘导致膈肌功能障碍，进而引发氯氮平所致肺炎。此外，还概述了对临床实践的启示。
