Department of Internal Medicine, Miyazaki Prefectural Miyazaki Hospital, Miyazaki, Japan.
Department of Psychiatry, Miyazaki Prefectural Miyazaki Hospital, Miyazaki, Japan.
Mod Rheumatol Case Rep. 2020 Jan;4(1):70-73. doi: 10.1080/24725625.2019.1628413. Epub 2019 Jun 20.
Clozapine is the most effective antipsychotic medication for refractory schizophrenia, but it has many possible serious side effects, including antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). However, the rare case reports available have not presented sufficient characteristic features of drug-induced AAV. Herein, we report a case of a 48-year-old Japanese woman with schizophrenia who presented with fever, arthralgia, myalgia and skin rash after 2 years of clozapine treatment. Her C-reactive protein (CRP) level increased, myeloperoxidase ANCA was positive and skin biopsy revealed leukocytoclastic vasculitis. Initially, steroid administration achieved remission, but her symptoms and high CRP levels relapsed every time the steroid dosage was tapered down. Upon discontinuation of clozapine, her symptoms and elevated CRP level immediately improved and the steroid was successfully tapered and discontinued. This outcome suggested that clozapine was the main cause of AAV.
氯氮平是治疗难治性精神分裂症最有效的抗精神病药物，但它有许多可能的严重副作用，包括抗中性粒细胞胞质抗体（ANCA）相关性血管炎（AAV）。然而，现有的罕见病例报告并没有呈现出药物诱导的 AAV 的充分特征。在此，我们报告一例 48 岁日本女性精神分裂症患者，在服用氯氮平 2 年后出现发热、关节痛、肌痛和皮疹。她的 C 反应蛋白（CRP）水平升高，髓过氧化物酶 ANCA 阳性，皮肤活检显示白细胞碎裂性血管炎。最初，给予类固醇治疗后缓解，但每次减少类固醇剂量时，她的症状和高 CRP 水平都会复发。停用氯氮平后，她的症状和升高的 CRP 水平立即改善，类固醇成功减停。这一结果提示氯氮平是 AAV 的主要原因。
