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Case Reports
. 2017 Sep 23;11(1):270.
doi: 10.1186/s13256-017-1447-4.

Clozapine-induced acute gastrointestinal necrosis: a case report

Mark T Osterman  1 , Caitlin Foley  1 , Isaac Matthias  2
Affiliations
Case Reports

Clozapine-induced acute gastrointestinal necrosis: a case report

Mark T Osterman et al. J Med Case Rep. .

Abstract

Background: Clozapine is known to cause fecal impaction and ileus with resultant colonic necrosis due to compression of colonic mucosa. There are rare reports of clozapine causing necrosis of other portions of the gastrointestinal tract unrelated to constipation. We describe a case of acute necrosis of the upper gastrointestinal tract and small bowel to due to clozapine and quetiapine.

Case presentation: A 66-year-old white man with a past medical history of schizophrenia, maintained on clozapine and quetiapine, presented with hypoxic respiratory failure caused by aspiration of feculent emesis due to impacted stool throughout his colon. His constipation resolved with discontinuation of clozapine and quetiapine, and his clinical condition improved. These medicines were restarted after 2 weeks, resulting in acute gastrointestinal necrosis from the mid esophagus through his entire small bowel. He died due to septic shock with Gram-negative rod bacteremia.

Conclusions: Clozapine may cause acute gastrointestinal necrosis.

Keywords: Acute bowel necrosis; Acute esophageal necrosis; Acute gastrointestinal necrosis; Antipsychotic; Clozapine; Quetiapine.

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Conflict of interest statement

Ethics approval and consent to participate

Not applicable.

Consent for publication

Written informed consent was obtained from the patient’s next of kin for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Abdominal X-ray showing diffuse small bowel dilation
Fig. 2
Fig. 2
Esophagogastroduodenoscopy images showing severe diffuse ulceration of the upper gastrointestinal tract. a Transition from normal to ulcerated mucosa in the mid esophagus, b distal esophagus, c stomach, and d duodenum
See this image and copyright information in PMC

References

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