Lessons Learned and Questions Raised by an Atypical Case ofClozapine-Induced Myocarditis

A Caucasian male in his early twenties suffering from treatment resistant schizophrenia was started on clozapine. After three dayshe developed tachycardia, a common side effect of clozapine induction. He had one temperature spike (38.9∘C) on day ten afterinduction but remained clinically well. An ECG and blood tests were normal. Due to persistent tachycardia and an episode ofcollapse whilst seated on day 12, he was admitted to hospital for further investigation. A diagnosis of myocarditis was confirmed asa result of elevated cardiac enzyme levels and an echocardiogram. Following withdrawal of clozapine, supportive management, andinitiation of cardiac medication, the patient made a successful recovery. He will be followed up with the cardiology team to ensurethat his heart function returns to normal. Given the incidence of clozapine-induced myocarditis, the associated mortality risk, anddiagnostic difficulties, this case raises questions about whether a formal system for identifying myocarditis should be adopted