A Case of Agranulocytosis Induced by Olanzapine and Treated with Granulocyte-Colony Stimulating Factor

Lee, Won Hee; Kim, Won; Chae, Jeong Ho; Jun, Tae Youn; Bahk, Won Myong

Abstract

Agranulocytosis is a severe hematologic complication of clozapine, but olanzapine was not shown to induce agranulocytois. Nevertheless, some cases of olanzapine-induced agranulocytosis have been reported, but there was no report yet in Korea. Recently we experienced that a female patient taking olanzapine suffered by fever and aganulocytosis, so treated by discontinuation of olanzapine and granulocyte-colony stimulating factor (GCSF). A 35 year-old psychotic women started a treatment with olanzapine. At the 10th hospital day, 9 days after administration of olanzapine, agranulocytosis accompanied with fever developed and aggravated in spite of discontinuation of olanzapine. At the 12th hospital day, G-CSF was administered and the hematologic complication improved. Thereafter haloperidol and ECT was administerd for treatment of psychotic symptoms. At 80 hospital day, the patient discharged with normal hematologic profile and improved state of psychotic symptoms. Agranulocytosis induced by olanzapine is not frequent, but it can be developed in some vulnerable patients. So, if a patient taking olanzapine shows fever, chill and sore throat, hematologic examination should be carried out. Once agranulocytosis develops, immediate discontinuation of olanzapine and other potential drug is essential. Thereafter, preventive antibiotics and shortening in duration of aganulocytosis are needed.