# Severe Clozapine-Induced Agranulocytosis, Pharmacodynamic Synergism, and Lithium Promyelocytic Effects in Granulocyte Colony-Stimulating Factor (G-CSF) Resistance or Delayed Response: A Case Report

## TL;DR

This case report describes a rare instance of severe agranulocytosis caused by multiple drugs and highlights the need for more research on lithium's potential to stimulate neutrophil production.

## Contribution

The paper introduces a case of treatment-resistant agranulocytosis and explores the synergistic effects of multiple drugs and lithium's promyelocytic properties.

## Key findings

- A patient had an absolute neutrophil count of zero while on Depakote, Haldol, and clozapine.
- The case suggests a need for further research on lithium's promyelocytic effects in G-CSF-resistant patients.
- The synergistic effect of multiple agranulocytosis-inducing drugs is under-researched.

## Abstract

Clozapine-induced agranulocytosis is documented in multiple studies, but there is limited literature on treatment-resistant agranulocytosis, the synergistic effect of multiple agranulocytosis-inducing drugs, and lithium's promyelocytic effects. This case highlights these gaps by discussing a patient with an absolute neutrophil count of zero while being treated with Depakote, Haldol, and clozapine. This case proposes more research on lithium's promyelocytic effects, especially in patients who are unresponsive or have a delayed response to discontinuing offending agents and granulocyte colony-stimulating factor (G-CSF).