T.A. is a 32-year-old man, born in Pakistan, with no previous psychiatric history or sound, who was taken to the emergency department of our hospital for behavioral changes in the public road.
Vital signs were taken before the patient was taken to the psychiatric emergency room, with an axillary temperature of 38oC.
An analytical test was requested in which only creatine kinase (CK) 1,125 IU/I stood out, with a total leukocyte count (TLR) of 8.92x103/ul and total neutrophils (NT) of 6.99
A chest X-ray was also performed which was normal, so the patient was referred to psychiatry with the diagnosis of upper respiratory tract infection of viral etiology.
Treatment with paracetamol 1 gr/8h was started and it was recommended to repeat the analytical to monitor CK levels.
In the psychiatric evaluation, the presence of positive psychotic symptoms was detected, in the form of delusional idea of prejudice, authenticity and hearing aids.
These delusional experiences had been the origin of behavioral changes and generated great emotional impact on the patient.
The patient was admitted to the psychiatric acute care unit and olanzapine treatment was initiated at a dose of 20 mg/day.
A new analytical control was requested three days after admission.
CK values had decreased to 943 IU/I and a TLR of 2.46x103/ul with TN of 0.64x103/ul was found in the blood count.
At that time the patient was receiving olanzapine and paracetamol as treatment, both drugs were started on the first day of admission.
After reviewing the literature, this leukopenia and neutropenia were associated with olanzapine.
Olanzapine was immediately discontinued and treatment with risperidone was initiated at a dose of 6 mg/day, maintaining treatment with paracetamol.
Close monitoring of white blood cell count was performed.
Four days after olanzapine withdrawal, TRL had risen to 3.66x103/ul and TN to 1.02x103/ul, continuing CK values in descending progression (237IU/I).
Progressively, the patient presented an attenuation of the psychotic clinic and an emotional distancing from delusional experiences, gradually performing critical of the psychotic clinic present at admission.
Because the patient was not aware of the disease, it was decided to start treatment with intramuscular zuclonus (IM) 200 mg every three weeks concomitantly with oral risperidone 6 mg/day.
Twelve days after the withdrawal of olanzapine and six days after initiation of treatment with peel juice, MI decanoate levels were normal, both TLR and TN had normalized (5.73x103/ul), respectively.
The patient's clinical stability was reduced, risperidone treatment was paulatinely decreased, and at discharge she received only treatment with zucchilo decanoate IM.
