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Clozapine-Induced Hypersensitivity Myocarditis*

Maurizio Pieroni, MD; Roberto Cavallaro, MD; Cristina Chimenti, MD, PhD; Enrico Smeraldi, MD; Andrea Frustaci, MD, FCCP
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*From the Cardio-Thoracic and Vascular Department (Drs. Pieroni and Chimenti) and the Department of Neuropsychiatric Sciences (Drs. Cavallaro and Smeraldi), San Raffaele Hospital, “Vita-Salute” University School of Medicine, Milan, Italy; and the Cardiology Department (Dr. Frustaci) Catholic University, Rome, Italy.

Correspondence to: Andrea Frustaci, MD, FCCP, Cardiology Department, Catholic University, Largo A. Gemelli 8, 00168 Rome, Italy; e-mail: biocard@rm.unicatt.it



Chest. 2004;126(5):1703-1705. doi:10.1378/chest.126.5.1703
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A rare, but frequently fatal, side effect of the antipsychotic drug clozapine is myocarditis. We report a case of hypersensitivity myocarditis secondary to clozapine administration that was diagnosed in vivo for the first time through endomyocardial biopsy and was successfully treated with corticosteroids. Histologic diagnosis was based on the evidence of eosinophilic infiltration of the endomyocardium and eosinophil degranulation. Endomyocardial biopsy was performed in order to establish or exclude a clear-cut relationship between cardiac dysfunction and clozapine, and was crucial to establish a correct diagnosis and appropriate treatment. Clozapine withdrawal and targeted 8-day, low-dose corticosteroid therapy resolved the symptoms and restored cardiac function.

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