Abstract：
Clozapine is one of the most effective antipsychotic drugs, but its use is limited due to the possibility of severe side effects, such as neutropenia and agranulocytosis. The risk of these complications is the highest at the beginning of the treatment, but they can occur later, particularly when additional risk factors are present. In the described case, either COVID-19 vaccination or the infection itself led to severe neutropenia, which recurred during subsequent independent trials of other antipsychotic drugs. The paper presents the case of a 23-year-old woman diagnosed with early-onset, treatment-resistant schizophrenia who had been undergoing clozapine treatment with satisfying outcome for over 10 years. A week after the first dose of an mRNA vaccine against COVID-19, the patient developed a severe SARS-CoV-2 infection and experienced an extreme neutropenia, followed by a change of treatment. Although the patient fully recovered from the infection, the re-stabilization of her mental state remained unsatisfactory. The introduction of various newly implemented antipsychotic drugs led to partial improvement or another decline in the neutrophil count, despite discontinuing the use of clozapine. The authors discuss a few possible pathomechanisms. Based on our current knowledge, this is the first reported case of persistent neutropenia triggered by various antipsychotic drugs following exposure to SARS-CoV-2 antigens.
摘要：
氯氮平是最有效的抗精神病药物之一,但是由于严重副作用的可能性，它的使用受到限制，如中性粒细胞减少症和粒细胞缺乏症。这些并发症的风险在治疗开始时最高，但是它们可以在以后发生，特别是当存在其他风险因素时。在描述的情况下，COVID-19疫苗接种或感染本身导致严重的中性粒细胞减少，在随后的其他抗精神病药物的独立试验中复发。本文介绍了一名23岁女性被诊断为早发性的病例，治疗耐药的精神分裂症患者接受氯氮平治疗超过10年，结果令人满意。在第一剂针对COVID-19的mRNA疫苗的一周后，患者出现了严重的SARS-CoV-2感染，并出现了严重的中性粒细胞减少症，随后是治疗的改变。虽然病人完全从感染中康复,她的精神状态的重新稳定仍然不令人满意。各种新实施的抗精神病药物的引入导致中性粒细胞计数的部分改善或另一个下降，尽管停止使用氯氮平.作者讨论了一些可能的病理机制。根据我们目前的知识,这是首例报道的由各种抗精神病药物在暴露于SARS-CoV-2抗原后引发的持续性中性粒细胞减少症病例.
