Treatment of Clozapine-Induced Agranulocytosis Associated with Complications / 신경정신의학

ABSTRACT

The authors reported a case of clozapine-induced agranulocytosis that combined with serious complications in a 37-years-old male patient with chronic schizophrenia. Clozapine-induced agranulocytosis developed on Day 51 of clozapine treatment. The patient was transferred to hematologic department and then treated by massive antibiotics in aseptic room. After the injection of G-CSF, WBC count increased to the normal range. But the day after the normalization of WBC count, patient's general condition was worsened with fever and mild rigidity, and also CK, LDH, BUN/Cr, and LFT was increased. The patient's elevated laboratory findings with those of physical signs and symptoms suggested the neuroleptic malignant syndrome and acute renal failure. Eventually steroid was administered to the patient, and then patient's general condition and laboratory findings were normalized. We suggest that the identification of risk factors and careful regular blood monitoring is the best method for the prevention of clozapine-induced agranulocytosis. After the onset of clozapine-induced agranulocytosis, clozapine should be discontinued immediately and proper antibiotic therapy with administration of G-CSF should be done, as soon as possible. And we emphasize the importance of the education and the establishment of therapeutic relationship with patients and their family also.