Clozapine-Induced Acute Generalized Exanthematous Pustulosis: A Case Report
DOI:
https://doi.org/10.52206/jsmc.2025.15.4.1095Abstract
Background: Background: Clozapine is one of the most effective treatments for resistant schizophrenia; however, it can cause severe hematological and, rarely, dermatological reactions.
Case Presentation: We describe a 25-year-old woman with treatment-resistant schizophrenia who developed acute generalized exanthematous pustulosis (AGEP) four days after clozapine initiation. The rash appeared as widespread erythematous pustules over the face, trunk, and limbs, confirmed clinically as AGEP. Clozapine was discontinued, and she was treated with oral antihistamines and topical calamine, leading to full recovery within two weeks.
Discussion: Clozapine-induced AGEP is exceedingly rare, with few cases reported in the literature. The reaction is thought to result from a type IV hypersensitivity mechanism. Prompt recognition, drug withdrawal, and multidisciplinary care are crucial for favorable outcomes.
Conclusion: This case underscores the importance of dermatological monitoring in patients receiving clozapine. Early identification and intervention can prevent complications and optimize treatment continuity.
Keywords: Acute Generalized Exanthematous Pustulosis, Adverse drug reaction, Clozapine, Schizophrenia, Skin eruption.
References
Al-Aojan S, Al-Khalifah A. Clozapine-Induced Phototoxicity: An Unusual Side Effect of Atypical Antipsychotics. Case Reports in Dermatology and Medicine. 2018;2018:9242515. http://doi.org/10.1155/2018/9242515
Bujor CE, Vang T, Nielsen J, et al. Antipsychotic-Associated Psoriatic Rash: A Case Report. BMC Psychiatry. 2017;17:242. https://doi.org/10.1186/s12888-017-1411-2
El Ouni Amami N, Ali-Diabacte H, Ateb S, et al. Clozapine-Induced Cholinergic Urticaria: A Case Report. Therapeutic Advances in Psychopharmacology. 2024;14. https://doi.org/10.1177/204512532412410
Güler HA, Türko?lu S, Güler D. The Maculopapular Rash Associated with Risperidone in a Child. Psychiatry and Clinical Psychopharmacology. 2019;29(4):527-528. http://doi.org/10.1080/24750573.2018.1468639
Lai YW, Chou CY, Shen WW, Lu ML. Pityriasis Rosea-Like Eruption Associated With Clozapine: A Case Report. General Hospital Psychiatry. 2012;34(6):703.e5–7. http://doi.org/10.1016/j.genhosppsych.2012.03.002
Lin J. Antipsychotics and Rashes. Mental Illness. 2018;10(2):7808. https://doi.org/10.4081/mi.2018.7808
Nath S, Rehman S, Kalita KN, Baruah A. Aripiprazole-Induced Skin Rash. Indian Psychiatry Journal. 2016;25(2):225-226.
Shah M, Karia S, Merchant H, Shah N, de Sousa A. Risperidone-Induced Skin Rash in an Elderly Female. Journal of Geriatric Mental Health. 2019;6(1):28-30. http://doi.org/10.4103/jgmh.jgmh_7_19
Stoppe G, Müller P, Fuchs T, Rüther E. Life-Threatening Allergic Reaction to Clozapine. British Journal of Psychiatry. 1992;161(2):259-261. http://doi.org/10.1192/bjp.161.2.259
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