Intravenous Immunoglobulin and Methylprednisolone for Clozapine-Associated Perimyocarditis

Am J Ther. 2019 Jul/Aug;26(4):e485-e486. doi: 10.1097/MJT.0000000000000751.

Abstract

Clinical features: Cardiotoxicity is a rare but serious side effect of clozapine. We present a case of a psychiatric patient on chronic clozapine 75 mg daily, who presented with congestive heart failure secondary to the cardiotoxic effects of the psychiatric medication.

Therapeutic challenge: Conventional heart failure treatment failed to improve symptoms.

Solution: A course of 40 mg of intravenous immunoglobulin and 125 mg of steroids was implemented, after which the patient made a full recovery. We hope to raise awareness of concurrent clozapine-induced pericarditis and myocarditis and propose a role of intravenous immunoglobulin and steroids in the treatment of drug-induced cardiomyopathy.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Biopsy
  • Cardiotoxicity / diagnosis
  • Cardiotoxicity / drug therapy
  • Cardiotoxicity / etiology
  • Clozapine / adverse effects*
  • Drug Therapy, Combination
  • Electrocardiography
  • Humans
  • Immunoglobulins, Intravenous / therapeutic use*
  • Male
  • Methylprednisolone / therapeutic use*
  • Myocarditis / chemically induced
  • Myocarditis / diagnosis
  • Myocarditis / drug therapy*
  • Myocardium / pathology
  • Pericarditis / chemically induced
  • Pericarditis / diagnosis
  • Pericarditis / drug therapy*
  • Pericardium / drug effects
  • Pericardium / pathology
  • Psychotic Disorders / drug therapy
  • Treatment Outcome

Substances

  • Immunoglobulins, Intravenous
  • Clozapine
  • Methylprednisolone