Clozapine is the most effective antipsychotic medication for treatment-resistant schizophrenia but is associated with rare and potentially life-threatening myocarditis. Early clinical manifestations are often nonspecific and may delay diagnosis. We report a man in his 30s who developed fever and palpitations three weeks after initiation of clozapine therapy. Laboratory testing demonstrated a marked elevation in C-reactive protein that preceded the development of cardiac biomarker elevation and new left ventricular systolic dysfunction. Transthoracic echocardiography demonstrated an ejection fraction of 30% to 35%, consistent with acute heart failure with reduced ejection fraction. Clozapine was discontinued, and guideline-directed medical therapy was initiated, resulting in complete recovery of cardiac function on follow-up imaging. This case highlights the potential role of inflammatory markers as an early signal of evolving clozapine-associated myocarditis and emphasizes the importance of early recognition and prompt drug discontinuation.
Abstract
Case Reports
Journal Article
eng
42037969
Roomiany, Pahresah, et al. "Clozapine-Associated Myocarditis Presenting With Acute Heart Failure: Inflammation Before Injury." Cureus, vol. 18, no. 3, 2026, pp. e105736.
Roomiany P, Eshraghi A, Farber F. Clozapine-Associated Myocarditis Presenting With Acute Heart Failure: Inflammation Before Injury. Cureus. 2026;18(3):e105736.
Roomiany, P., Eshraghi, A., & Farber, F. (2026). Clozapine-Associated Myocarditis Presenting With Acute Heart Failure: Inflammation Before Injury. Cureus, 18(3), e105736. https://doi.org/10.7759/cureus.105736
Roomiany P, Eshraghi A, Farber F. Clozapine-Associated Myocarditis Presenting With Acute Heart Failure: Inflammation Before Injury. Cureus. 2026;18(3):e105736. PubMed PMID: 42037969.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR
T1 - Clozapine-Associated Myocarditis Presenting With Acute Heart Failure: Inflammation Before Injury.
AU - Roomiany,Pahresah,
AU - Eshraghi,Anisa,
AU - Farber,Faye,
Y1 - 2026/03/23/
PY - 2026/03/23/accepted
PY - 2026/4/27/medline
PY - 2026/4/27/pubmed
PY - 2026/4/27/entrez
KW - antipsychotic complications
KW - c-reactive protein
KW - clozapine
KW - drug induced cardiomyopathy
KW - drug toxicity
KW - heart failure
KW - myocarditis
SP - e105736
EP - e105736
JF - Cureus
JO - Cureus
VL - 18
IS - 3
N2 - Clozapine is the most effective antipsychotic medication for treatment-resistant schizophrenia but is associated with rare and potentially life-threatening myocarditis. Early clinical manifestations are often nonspecific and may delay diagnosis. We report a man in his 30s who developed fever and palpitations three weeks after initiation of clozapine therapy. Laboratory testing demonstrated a marked elevation in C-reactive protein that preceded the development of cardiac biomarker elevation and new left ventricular systolic dysfunction. Transthoracic echocardiography demonstrated an ejection fraction of 30% to 35%, consistent with acute heart failure with reduced ejection fraction. Clozapine was discontinued, and guideline-directed medical therapy was initiated, resulting in complete recovery of cardiac function on follow-up imaging. This case highlights the potential role of inflammatory markers as an early signal of evolving clozapine-associated myocarditis and emphasizes the importance of early recognition and prompt drug discontinuation.
SN - 2168-8184
UR - https://www.unboundmedicine.com/prime/citation/42037969/Clozapine-Associated_Myocarditis_Presenting_With_Acute_Heart_Failure:_Inflammation_Before_Injury.
DB - PRIME
DP - Unbound Medicine
ER -
