J Med Cases
Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc
Journal website http://www.journalmc.org

Case Report

Volume 4, Number 12, December 2013, pages 780-781


A Case of Eosinophilia Associated With Olanzapine

Hidetaka Yamadaa, b, c, Shigenari Ohmuraa, Naohisa Uchimuraa

aDepartment of Neuropsychiatry, Kurume University School of Medicine, 67 Asahimachi, Kurume, Fukuoka, Japan
bDepartment of Psychiatry, Kurume University Medical Center, 155-1 Kokubumachi, Kurume, Fukuoka 839-0863, Japan
cCorresponding author: Hidetaka Yamada, Department of Psychiatry, Kurume University Medical Center, 155-1 Kokubumachi, Kurume, Fukuoka 839-0863, Japan

Manuscript accepted for publication October 18, 2013
Short title: Eosinophilia Associated With Olanzapine
doi: https://doi.org/10.4021/jmc1535w

Abstract▴Top 

Olanzapine is an atypical antipsychotic medication that was originally developed for the treatment of schizophrenia. We report a case of eosinophilia possibly associated with olanzapine treatment for a recurrent manic episode. Although olanzapine is a potent agent for various psychiatric disorders, hematological complications should be taken into consideration as a possible adverse reaction.

Keywords: Olanzapine; Eosinophilia; Side effect

Introduction▴Top 

Olanzapine is an atypical antipsychotic medication that was originally developed for the treatment of schizophrenia. It has also been shown to have broad efficacy in the treatment of bipolar disorder and manic episodes [1]. In addition to the commonly known adverse effects of this drug, including high blood sugar and/or weight gain, a few reports have indicated hematological toxicity as an adverse effect [2, 3]. However, only one case report of eosinophilia has been published to date [4]. We report a case of eosinophilia possibly associated with olanzapine treatment for a recurrent manic episode.

Case Report▴Top 

The patient, a 65-year-old woman, was admitted for dyspnea and fever and diagnosed with aspiration pneumonia. She was treated with antibiotics and a few days later, her symptoms improved. During the treatment, we were consulted for her decreased need to sleep, talkativeness, euphoric mood, excessive inquisitiveness, and hyperactivity. Her husband reported that she had been diagnosed with cyclothymic personality and developed hypomanic episode on occasion, although she had never been treated for those episodes. She was diagnosed with bipolar disorder and olanzapine treatment, 10 mg/day, was started.

Before the beginning of olanzapine treatment, her white blood cell (WBC) count and eosinophil count were 5,120/L and 548/L, respectively, making eosinophils 10.7% of the total WBC count. Four days after the induction of treatment, her WBC count had increased to 7,670/L, of which 2,000/L, or 26.0% of the total WBC count, was eosinophils. At this point, drugs possibly associated with eosinophilia such as antibiotics and NSAIDs were terminated and a parasitic infection and other causes of eosinophilia were excluded. Olanzapine treatment was discontinued in consultation with the internal medicine specialist. Two weeks after olanzapine cessation, the eosinophil counts had decreased to 12.0%. In addition, the lymphocyte count had transiently decreased to 15% of the total WBC count, and had increased to the normal range as eosinophil counts declined.

Discussion▴Top 

Blood eosinophilia, which is the presence of > 500/L of eosinophils, signifies either a cytokine-mediated reactive phenomenon (secondary) or an integral phenotype of an underlying hematological neoplasm (primary) [5]. Secondary eosinophilia is usually associated with parasitosis and allergic conditions including drug allergy [5]. Antibiotics or NSAIDs are often identified as a causative agent, and with regard to atypical antipsychotics, it is well established that clozapine can cause eosinophilia, which is often associated with organ-specific inflammatory processes [6]. One of the most distinctive findings of the present case is that the patient developed eosinophilia without leukocytosis. Eosinophilia is typically accompanied by leukocytosis and in the case reported by Mathias et al [4], the total WBC count increased up to 14.9 х 109/L, half of which were eosinophils. Eosinophilia appears to be asymptomatic in general, yet eosinophil counts > 2,000/L can cause organ toxicity [6]. Although it is not known exactly why the total WBC count did not increase in our case, we should look for important diagnostic clues for allergic reactions to medications, including eosinophilia, by measuring differential leukocyte counts. In conclusion, olanzapine is a potent agent for various psychiatric disorders, including schizophrenia and manic disorder; however, impaired glucose tolerance and/or weight gain are common adverse effects, and hematological complications should be taken into consideration as a possible adverse reaction.


References▴Top 
  1. Lieberman DZ, Goodwin FK. Use of olanzapine in the treatment of bipolar I disorder. Expert Rev Neurother. 2004;4:759-767.
    doi pubmed
  2. Naumann R, Felber W, Heilemann H, Reuster T. Olanzapine-induced agranulocytosis. Lancet. 1999;354(9178):566-567.
    doi
  3. Gajwani P, Tesar GE. Olanzapine-induced neutropenia. Psychosomatics. 2000;41:150-151.
    doi pubmed
  4. Mathias S, Schaaf LW, Sonntag A. Eosinophilia associated with olanzapine. J Clin Psychiatry. 2002;63(3):246-247.
    doi pubmed
  5. Tefferi A, Patnaik MM, Pardanani A. Eosinophilia: secondary, clonal and idiopathic. Br J Haematol. 2006;133(5):468-492.
    doi pubmed
  6. Roberts CE, Mortenson LY, Merrill DB, Rafizadeh N, Smith TE, Lieberman JA. Successful rechallenge with clozapine after eosinophilia. Am J Psychiatry. 2011;168(11):1147-1151.
    doi pubmed


This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Journal of Medical Cases is published by Elmer Press Inc.

 
Home     |     Log In     |      About     |      Search     |      Current     |      Archives     |      Submit      |     Subscribe


 

     

Aims and Scope

Current Issues

Conflict of Interest

About Publisher

Editorial Board

Archives

Copyright

Company Profile

Editorial Office

Misconduct and Retraction

Permissions

Company Registration

Contact Us

Abstracting and Indexing

ICMJE

Ownership

Instructions to Authors

Access

Declaration of Helsinki

Contact Publisher

Submission Checklist

Reprints

Terms of Use

Company Address

Submit a Manuscript

Open Access Policy

Privacy Policy

Browse Journals

Publishing Fee

Publishing Policy

Disclaimer

Recent Highlights

Peer-Review Process

Publishing Quality

Code of Ethics

Advertising Policy

Manuscript Tracking

Advanced Search

For Librarians

Careers

Publishing Process

Publication Frequency

For Reviewers

Propose a New Journal

       
       

Journal of Medical Cases, monthly, ISSN 1923-4155 (print), 1923-4163 (online), published by Elmer Press Inc.        
The content of this site is intended for health care professionals.
This is an open-access journal distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, which permits unrestricted
non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Creative Commons Attribution license (Attribution-NonCommercial 4.0 International CC-BY-NC 4.0)


This journal follows the International Committee of Medical Journal Editors (ICMJE) recommendations for manuscripts submitted to biomedical journals,
the Committee on Publication Ethics (COPE) guidelines, and the Principles of Transparency and Best Practice in Scholarly Publishing.

website: www.journalmc.org   editorial contact: editor@journalmc.org
Address: 9225 Leslie Street, Suite 201, Richmond Hill, Ontario, L4B 3H6, Canada

© Elmer Press Inc. All Rights Reserved.

DECLARATION: THIS JOURNAL SITE OUTLOOK IS DESIGNED BY THE PUBLISHER AND COPYRIGHT PROTECTED. DO NOT COPY!