Smith Leo T, Symons Evan, Hare James L, Hooper Michelle, Fitzgerald Paul B
Psychiatry Registrar, Alfred Hospital, Department of Psychiatry, Melbourne, VIC, Australia
Psychiatrist, Alfred Hospital, Department of Psychiatry, Melbourne, VIC, Australia.
Australas Psychiatry. 2014 Dec;22(6):539-42. doi: 10.1177/1039856214553314. Epub 2014 Oct 13.
We present a case of confirmed clozapine-induced myocarditis in a patient who was not naïve to the drug.
This patient, who had been stable on clozapine for 10 years, relapsed following self-cessation. Asymptomatic throughout inpatient re-titration, serum cardiac enzymes were nonetheless routinely taken.
Occult myocarditis was only discovered due to an elevated Troponin I, and was confirmed by cardiac imaging.
Once thought to be the preserve of initial exposure to the medication, clozapine-induced myocarditis can occur at any re-titration point if the immunological milieu permits. We therefore recommend routine monitoring of serum cardiac enzymes with all patients undergoing titration of clozapine, regardless of whether they have previously been stable on the drug.
我们报告一例确诊为氯氮平所致心肌炎的病例，该患者并非初次使用该药。
该患者服用氯氮平10年病情稳定，自行停药后病情复发。住院重新滴定剂量过程中一直无症状，但仍常规检测血清心肌酶。
因肌钙蛋白I升高才发现隐匿性心肌炎，并经心脏成像确诊。
氯氮平所致心肌炎曾被认为仅发生于初次用药时，但若免疫环境允许，在任何重新滴定剂量阶段都可能发生。因此，我们建议对所有接受氯氮平滴定的患者常规监测血清心肌酶，无论他们之前使用该药时病情是否稳定。
