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

## TL;DR

A case of severe neutropenia caused by clozapine and myelodysplastic syndrome highlights the need for a team-based approach to manage complex medical conditions.

## Contribution

The paper emphasizes the importance of a multidisciplinary approach in managing overlapping hematologic and psychiatric conditions.

## Key findings

- Febrile neutropenia persisted despite stopping clozapine and antibiotic treatment, suggesting an underlying myelodysplastic syndrome.
- The combination of CIA and MDS-EB2 worsened the patient's prognosis and required collaboration across specialties.
- A bone biopsy confirmed myelodysplastic syndrome, highlighting the diagnostic complexity of the case.

## Abstract

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).