Pulmonary Thromboembolism Associated with Olanzapine Treatment

To the Editor: A 55‐year‐old female was admitted to the emergency department of our hospital complaining of dyspnea after catching a bus for about 5 m during last day. She had a past history of suffering from depression mood disorder recently and could not sleep well at night for which she was started on olanzapine tablets 10 mg/d, sertraline hydrochloride tablets 50 mg/d and oxazepam tablets 15 mg/d for 28 days by a physician of psychiatric hospital. She was otherwise without receiving any other medicine, including oral contraceptive, illicit drugs or alcohol and had no history of smoking, recent surgery, trauma, peripheral vascular disease, cancer or cardiovascular disease. What’s more, she did not have a demonstrable lowered activity level or weight change recently. On admission, the vital signs recorded were: blood pressure 100/70 mmHg, heart rate 100 beats/min, respiratory rate 18 breaths/min, T 36.5°C, body mass index was 23 kg/m2. Cardiovascular, respiratory, abdominal and neurological examinations were unremarkable. Arterial blood gas analysis showed hypoxemia and hypocapnia (PO2 49 mmHg, PCO2 27.5 mmHg, SO2 85.7%), plasma D‐dimer was 11.79 mg/L. Blood routine revealed white blood cell count 11.49 × 109/L with 74.8% neutrophils and platelet count 142 × 109/L, hemoglobin 135 g/L. Cardiac enzyme showed cTnI was 0.066 ng/ml, a little higher than the normal range, but CK‐MB as well as liver and renal function test were normal. Electrocardiogram showed T‐wave inversion on III, V1‐V3 leads. And computed tomographic pulmonary angiography (CTPA) demonstrated multiple pulmonary emboli on both lobes accompany with a relatively small amount of fluid on the right interlobar fissure [Figure 1a‐1c]. Venous thrombosis between right calf muscle was discovered on bilateral Doppler ultrasound of the lower limbs. The ultrasonic cardiogram did not show