Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Pirkanmaa Hospital District, Tampere, Finland.
J Clin Psychopharmacol. 2020 May/Jun;40(3):293-296. doi: 10.1097/JCP.0000000000001204.
During clozapine treatment, diarrhea is a rare but clinically relevant adverse effect. Cases of microscopic colitis and eosinophilic colitis have been previously reported.
We present 4 patients who developed severe diarrhea in early weeks of clozapine therapy.
Two patients had significant peripheral eosinophilia 1 week after diarrhea symptoms. One of these patients also had Charcot-Leyden crystals in stool afterward, confirming the presence of eosinophils in the gut lumen. One of our patients had a confirmed microscopic colitis and later also neutropenia, which required treatment.
Charcot-Leyden crystals in stool may be associated with concurrent diarrhea and eosinophilia during clozapine treatment, which is a previously unreported finding. Occurrence of blood dyscrasias with diarrhea symptoms during clozapine treatment needs further investigation to understand the possible shared mechanisms.
氯氮平治疗期间，腹泻是一种罕见但具有临床相关性的不良反应。此前已有报道出现显微镜结肠炎和嗜酸性结肠炎病例。
我们报告了 4 例在氯氮平治疗早期出现严重腹泻的患者。
2 例患者在腹泻症状出现 1 周后外周血嗜酸性粒细胞显著增多。其中 1 例患者的粪便中还存在夏科-莱登结晶，证实嗜酸性粒细胞存在于肠腔中。我们的 1 例患者经证实患有显微镜结肠炎，后来还出现中性粒细胞减少症，需要治疗。
粪便中夏科-莱登结晶可能与氯氮平治疗期间同时出现的腹泻和嗜酸性粒细胞增多有关，这是一个以前未被报道的发现。氯氮平治疗期间出现血液学异常伴腹泻症状需要进一步研究以了解可能存在的共同机制。
