- 증 례

Size: px

Start display at page:

Download "- 증 례 - - - 481"

지헌 박
8 years ago
Views:

1 KISEP Case Report 올란자핀에 의해 유발되고 과립구 콜로니 자극 인자로 치료된 무과립구증 환자 1예 이원희 김 원 채정호 전태연 박원명 가톨릭대학교 의과대학 정신과학교실 ABSTRACT A Case of Agranulocytosis Induced by Olanzapine and Treated with Granulocyte-Colony Stimulating Factor Won-Hee Lee, MD, Won Kim, MD, Jeong-Ho Chae, MD, Tae-Youn Jun, MD and Won-Myong Bahk, MD Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea 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 G- CSF. 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. (Korean J Psychopharmacol 2004; 15(4): ) KEY WORDS:Olanzapine Agranulocytosis Granulocyte-colony stimulating factor. 서 교신저자 론 480

of Korea, Seoul, Korea Agranulocytosis is a severe hematologic complication of clozapine, but olanzapine was not shown to induce agranulocytois.

2 - 증 례

3 482 고 찰 - - Korean J Psychopharmacol 2004;15(4):

4 - 중심 단어 참고문헌 1) Alvir JM, Lieberman JA, Safferman AZ, Schwimmer JL, Schaaf JA. Clozapine-induced agranulocytosis. Incidence and risk factors in the United States. N Engl J Med 1993;329: ) Casey DE. The relationship of pharmacology to side effects. J Clin Psychiatry 1997;58 Suppl 10: ) Textbook of clinical psychiatry. 4th edition. Robert E. Hales, Stuart G. Yudofsky pate American Psychiatric Publishing, INC. Washington, DC the U.S 4) Oyewumi LK, Al-Semaan Y. Olanzapine: safe during clozapine-induced agranulocytosis. J Clin Psychopharmacol 2000;20: ) Swartz JR, Ananth J, Smith MW, Burgoyne KS, Gadasally R, Arai Y. Olanzapine treatment after clozapine-induced granulocytopenia in 3 patients. J Clin Psychiatry 1999;60: ) Tolosa-Vilella C, Ruiz-Ripoll A, Mari-Alfonso B, Naval-Sendra 483

Yudofsky pate 1099-1100. American Psychiatric Publishing, INC. Washington, DC the U.S 4) Oyewumi LK, Al-Semaan Y. Olanzapine: safe during clozapine-induced agranulocytosis.

5 E. Olanzapine-induced agranulocytosis: a case report and review of the literature. Prog Neuropsychopharmacol Biol Psychiatry 2002;26: ) Dettling M, Cascorbi I, Hellweg R, Deicke U, Weise L, Muller- Oerlinghausen B. Genetic determinants of drug-induced agranulocytosis: potential risk of olanzapine? Pharmacopsychiatry 1999;32: ) 이준석 김광일 김인순. Clozapine-유발성 무과립구증의 G- CSF 치료 경험 1예. 신경정신의학 1997;36: ) 천영훈 박민철. 합병증을 동반한 Clozapine-유발성 무과립 구증의 치료 경험 1예. 신경정신의학 2000;39: ) Gerson SL G-CSF and management of clozapine-induced agranulocytosis. J Clin Psychiatry 1994;55 Suppl B: ) Oyewumi LK, Al-Semaan Y. Olanzapine: safe during clozapine-induced agranulocytosis. J Clin Psychopharmacol 2000;20: ) Bilici M, Tekelioglu Y, Efendioglu S, Ovali E, Ulgen M. The influence of olanzapine on immune cells in patients with schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2003;27: ) Mason RP, Fischer V. Possible role of free radical formation in drug-induced agranulocytosis. Drug Saf 1992;7 Suppl 1: ) Duggal HS, Gates C, Pathak PC. Olanzapine-induced neutropenia: mechanism and treatment. J Clin Psychopharmacol 2004; 24: ) Benedetti F, Cavallaro R, Smeraldi E. Olanzapine-induced neutropenia after clozapine-induced neutropenia. Lancet 1999;354: ) Steinwachs A, Grohmann R, Pedrosa F, Ruther E, Schwerdtner I. Two cases of olanzapine-induced reversible neutropenia. Pharmacopsychiatry 1999;32: ) Gajwani P, Tesar GE. Olanzapine-induced neutropenia. Psychosomatics 2000;41: ) Gerson SL, Meltzer H. Mechanisms of clozapine-induced agranulocytosis. Drug Saf 1992;7 Suppl 1: ) Lamberti JS, Bellnier TJ, Schwarzkopf SB, Schneider E. Filgrastim treatment of three patients with clozapine-induced agranulocytosis. J Clin Psychiatry 1995;56: ) Chengappa KN, Gopalani A, Haught MK, McChesney K, Baker RW, Schooler NR. The treatment of clozapine-associated agranulocytosis with granulocyte colony-stimulating factor G- CSF. Psychopharmacol Bull 1996;32: Korean J Psychopharmacol 2004;15(4):

Pharmacopsychiatry 1999;32:110-112. 8) 이준석 김광일 김인순. Clozapine-유발성 무과립구증의 G- CSF 치료 경험 1예. 신경정신의학 1997;36:763-767. 9) 천영훈 박민철. 합병증을 동반한 Clozapine-유발성 무과립 구증의 치료 경험 1예. 신경정신의학 2000;39:463-469.

A 617

A 617 Special Issue Diabetic Retinopathy Won Ki Lee, M.D. Department of Ophthalmology The Catholic University of Korea College of Medicine Kangnam St. Mary s Hospital E mail : wklee@catholic.ac.kr Abstract R