Febrile Neutropenia in the Context of Clozapine-Induced Agranulocytosis (CIA) and Myelodysplastic Syndrome: Importance of a Multidisciplinary Approach

Febrile neutropenia (FN) constitutes a medical emergency, with significant associated mortality, and should be addressed by a multidisciplinary team. We present a case of FN in the context of clozapine-induced agranulocytosis (CIA) superimposed on myelodysplastic syndrome with excess type 2 blasts (MDS-EB2). The mechanism by which clozapine induces agranulocytosis remains unclear, but it represents an idiosyncratic reaction affecting few patients. In the case described, neutropenia maintained a downward kinetics (nadir 0 neutrophils) even after discontinuation of the antipsychotic and the institution of targeted antibiotic therapy, which prompted a myelogram and bone biopsy, consistent with myelodysplastic syndrome. This overlapping of pathologies has contributed to the severity of the neutropenia and leads to a worse prognosis. The complexity of the case required frequent collaboration with other specialties (hematology and psychiatry).