CLOZAPINE-INDUCED RECURRENT ASPIRATION PNEUMONIA

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Clozapine is a second-generation antipsychotic used for schizophrenia and treatment-resistant bipolar disorder. Some of its known side effects include agranulocytosis, seizures, myocarditis. However, clozapine-induced aspiration pneumonia not well known. We present case 70-year-old male with schizoaffective disorder on clozapine who underwent multiple admissions recurrent pneumonia, which upon further analysis was noted to be secondary use. CASE PRESENTATION: A patient past medical history disorder, neurocognitive decline, oropharyngeal dysphagia, tracheostomy, gastrostomy s/p stroke 14 years ago presented from nursing home chief complaint shortness breath. Since the gastrostomy, had been NPO received intermittent tube feeds. He stable dose 125mg bid several years. Upon presentation, he febrile 102 F, decreased breath sounds right, right-sided infiltrates were CXR. diagnosed started broad-spectrum antibiotics. Sputum cultures grew pseudomonas. The discharged after completing 7 days Zosyn. During admission, held concerns sedation aspiration. After his discharge, restarted lower gradual up-titration. Within two months again fever, increased work breathing, green discharge tracheostomy tube. treated, discharged. during this admission as well. continued have episodes total over 8 months. On last ultimately succumbed illness. DISCUSSION: This shows importance considering pneumonia. It proposed that muscarinic M4 agonism, alpha-2 adrenergic antagonism, inhibition swallowing reflex cause sedation, sialorrhea, accumulation saliva, esophageal peristalsis, all increases risk aspiration[1]. Studies by Yang et al. Hung found only associated an patients re-exposed higher recurrence[2,3]. CONCLUSIONS: report highlights one lesser-known clozapine. also illustrates regularly reevaluating medication efficacy safety. Sedative psychiatric medications are usually admissions, then can detrimental effect patient's health. REFERENCE #1: Kaplan J, Schwartz AC, Ward MC: Clozapine-Associated Aspiration Pneumonia: Series Review Literature. Psychosomatics. 2018, 59:199–203. 10.1016/j.psym.2017.08.011 #2: S-Y, Liao Y-T, Liu H-C, Chen WJ, C-C, Kuo C-J: Antipsychotic drugs, mood stabilizers, in disorder: nationwide case-control study. J Clin Psychiatry. 2013, 74:e79-86. 10.4088/JCP.12m07938 #3: GC-L, Pan C-H, reexposure schizophrenia: nested 2016, 77:60–6. 10.4088/JCP.14m09301 DISCLOSURES: No relevant relationships Ali Khoskish, source=Web Response Ashley Malekunnel, nitish singh nandu, Preeti Vadlamani,