- Clozapine is highly effective for treatment-resistant psychoses but can cause significant inflammatory adverse effects, including fever, myocarditis, pneumonia, and enteritis.
- Rapid titration precipitated fever, pulmonary inflammation, myalgia, gastrointestinal symptoms, leukocytosis with neutrophilia, and raised C-reactive protein in a 21-year-old patient.
- Vigilant serial monitoring of inflammatory markers and personalised, slower titration can prevent recurrence, particularly in East Asian populations at potentially higher risk.
Front Psychiatry. 2026 Aug 28;17:1886320. doi: 10.3389/fpsyt.2026.1886320. eCollection 2026.
ABSTRACT
INTRODUCTION: Clozapine is highly effective for treatment-resistant schizophrenia, schizoaffective disorder, and treatment-resistant mania. However, it is associated with significant inflammatory adverse effects, including fever and severe organ involvement such as myocarditis, pneumonia, and enteritis. Close serial monitoring of inflammatory markers (white blood cell count, C-reactive protein, and neutrophils) combined with individualized, slow dose titration is essential to minimize these risks.
CASE REPORT: We describe a 21-year-old Chinese male with treatment-resistant mania who developed fever, pulmonary inflammation, myalgia, nausea, vomiting, abdominal distension, leukocytosis with neutrophilia, and elevated C-reactive protein during the initial rapid titration of clozapine. The inflammatory response resolved promptly after dose reduction and did not recur with a slower titration schedule and lower maintenance dose.
CONCLUSIONS: This case highlights the importance of vigilant monitoring of inflammatory markers during clozapine initiation and supports the use of personalized titration regimens, particularly in East Asian populations who may be at heightened risk of clozapine-induced inflammation.
PMID:42729365 | PMC:PMC13561980 | DOI:10.3389/fpsyt.2026.1886320
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