Clozapine-Induced Gastrointestinal Hypoperfusion Leading to Bowel Ischemia and Secondary Atrial Fibrillation: A Case Report.

Abstract

Introduction: Clozapine is a highly effective antipsychotic for treatment-resistant schizophrenia but carries a risk of rare and serious adverse events. This case highlights a potentially fatal episode of clozapine-induced gastrointestinal hypoperfusion leading to bowel ischemia and secondary atrial fibrillation in a patient with chronic schizophrenia.

Main symptoms and clinical findings: A middle-aged male with longstanding schizophrenia presented with abdominal pain, vomiting, nausea, and persistent tachycardia. He was diagnosed with bowel ischemia from hypoperfusion and new-onset atrial fibrillation.

Intervention and outcome: Clozapine was discontinued. The patient underwent emergency laparotomy and supportive ICU care. His psychiatric management was shifted to haloperidol and olanzapine, and he returned close to his psychiatric baseline over time.

Conclusion: This case emphasizes the importance of monitoring for rare gastrointestinal complications associated with clozapine, including hypoperfusion-mediated bowel ischemia, and supports early recognition and prompt discontinuation to reduce morbidity and mortality.