We describe a case of a 21-year-old man who developed Clozapine induced myocarditis (CIM), an uncommon, but serious andpotentially life threatening, side-effect of Clozapine. The case is unusual because of presentation was atypical (symptoms, age, and timeframe of symptom-evolution), which increased the risk of the adverse event being missed. This report highlights the difficulties in thediagnosis of CIM in psychiatric patients with atypical presentations. A combination of unreliable history, uncertainties about risk factorsand absence of consensus guidelines about the speed of Clozapine titration. Clinicians are often unaware of the risk factors formyocarditis. Currently there is no mandatory requirement of laboratory monitoring for detecting myocarditis during Clozapine titration,unlike that for detecting neutropenia. The case report throws into sharp relief the need for vigilance and high index of suspicion duringClozapine titration. A protocol is suggested for close clinical monitoring and laboratory investigations during Clozapine titration, whichwill increase the chances of early detection and treatment of CIM, thus reducing the risk of high mortality.
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