SHM Converge Scientific Abstract ePoster Gallery-An Inconspicuous Case of Clozapine-Induced Myocarditis

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This case describes a 51-year-old man with paranoid schizophrenia, hypertension, and type 2 diabetes who was started on clozapine during psychiatric hospitalization for medication non-adherence. Within three weeks, he developed abdominal pain, vomiting, diarrhea, tachycardia, and mild lab abnormalities, including leukocytosis, hypercalcemia, and a small creatinine rise. CT imaging suggested ileus, so clozapine was stopped and he improved with IV fluids and bowel care.<br /><br />However, on hospital day 3 he developed new fever and persistent tachycardia. Cardiac and inflammatory markers became abnormal, with elevated BNP, troponin, and CRP, while cultures and other tests were unrevealing. Cardiac MRI confirmed myocarditis with mildly reduced left ventricular function (LVEF 42%), leading to the diagnosis of clozapine-induced myocarditis.<br /><br />The report emphasizes that clozapine, although highly effective for refractory schizophrenia and suicide prevention, can rarely cause myocarditis, usually within the first 1–3 months of initiation or dose escalation. Symptoms are often nonspecific and may include gastrointestinal complaints, fever, tachycardia, and signs of systemic inflammation, which can delay diagnosis. Recommended evaluation includes inflammatory and cardiac biomarkers, ECG, echocardiography, and confirmation with cardiac MRI or biopsy when needed.<br /><br />Treatment is immediate discontinuation of clozapine, supportive care, and consideration of heart failure guideline-directed therapy and steroids in selected cases. This patient improved with supportive management and was discharged on a beta blocker and angiotensin receptor blocker, with follow-up echocardiography planned.<br /><br />The key lesson is that hospitalists and psychiatrists should maintain a low threshold to evaluate for clozapine-induced myocarditis during early treatment, especially when nonspecific systemic symptoms arise.

Asset Subtitle

Jennifer DeSalvo

Meta Tag

Author List Allison Rossetti, Jennifer DeSalvo

Category Clinical Vignettes

Concept Clozapine

Concept Myocarditis

Concept Cardiac Biomarker

Concept Inflammatory Markers

Concept Electrocardiogram

Distinguished Non-Finalist

Presenter Organization The Ohio State University Medical Center/Nationwide Children's Hospital

Presenting Author Jennifer DeSalvo

Track Adult

Keywords

clozapine

myocarditis

schizophrenia

tachycardia

fever

abdominal pain

cardiac MRI

troponin

CRP

hospitalization

Clozapine

Myocarditis

Cardiac Biomarker

Inflammatory Markers

Electrocardiogram