[Clozapine-induced parotitis: a case study].

1. Encephale. 2014 Feb;40(1):81-5. doi: 10.1016/j.encep.2013.04.006. Epub 2013
Jun 27.

[Clozapine-induced parotitis: a case study].

[Article in French]

Gouzien C(1), Valiamé A(2), Misdrahi D(3).

Author information:
(1)Centre de référence régional des pathologies anxieuses et de la dépression,
centre expert dépression résistante fondation fondamental, Bordeaux cedex,
France; Université Bordeaux Segalen, 146, rue Léo-Saignat, 33077 Bordeaux cedex,
France; Pôle de psychiatrie adulte 347, centre hospitalier Charles-Perrens, 121,
rue de la Béchade, 33076 Bordeaux cedex, France.
(2)Pôle de psychiatrie adulte 347, centre hospitalier Charles-Perrens, 121, rue
de la Béchade, 33076 Bordeaux cedex, France.
(3)Pôle de psychiatrie adulte 347, centre hospitalier Charles-Perrens, 121, rue
de la Béchade, 33076 Bordeaux cedex, France; CNRS UMR 5287-Incia, université
Bordeaux Segalen, 146, rue Léo-Saignat, 33077 Bordeaux cedex, France. Electronic
address: .

INTRODUCTION: Clozapine is the drug of choice for patients with an
unsatisfactory response to routine antipsychotic treatment. Side effects such as
sedation, weight gain, hypotension and hypersialorrhea are frequently reported
whereas clozapine-induced parotitis is a less known complication.
CASE REPORT: We report the case of a 32-year-old woman with a refractory
schizoaffective disorder, bipolar type. The failure to respond to at least two
well-conducted antipsychotic trials with flupentixol and risperidone, led
clinicians to prescribe clozapine, which was started three years earlier. Since
its introduction, clozapine induced sialorrhea, which has been managed until now
with anticholinergic medication. Recently, Mrs B. was hospitalized for a new
relapse. Once treatment compliance checked (good level of plasmatic dosage), we
decided to increase the dose of clozapine from 350 mg/d to 500 mg/d. Twenty days
later, Mrs B. exhibited improvement of symptoms but complained of acute
bilateral auricular pain and odynophagia. The bilateral and comparative clinical
exam displayed a bilateral filling of the retromandibular depression, the
painful swelling of the parotid gland, along with ptyalism and a slight
inflammatory oedema of the Stenon duct orifice. Mrs B. was apyretic, with
physiological constants within the limits of normal values. The biological
analyses displayed a discrete inflammatory syndrome (mild hyperleucocytosis and
anemia), a negative mumps IgM test and positive mumps IgG test, and a 1050 ng/mL
clozapine blood level. Once viral parotitis was ruled out, the involvement of
clozapine was evoked. Symptomatic medication was prescribed with per os
analgesic (paracetamol) and antiseptic mouthwash (Éludril). Clozapine dosage was
lowered to 400 mg/d. A week later, clinical examination confirmed improvement of
the medical and psychiatric conditions.
DISCUSSION: We report the case of a patient who developed a parotitis following
clozapine dose adjustment. Clozapine induced parotitis was retained once the
infectious and other organic etiologies had been ruled out. Previous cases of
clozapine-induced parotitis have already been reported and we have some
arguments to suspect this etiology in our case. First, Mrs B. experienced more
hypersialorrhea with the increase in clozapine dosage. Second, the
anticholinergic medication was interrupted 3 days before the episode of
parotitis. Two main pathophysiological hypotheses, immune and inflammatory, have
already been proposed to explain clozapine-induced parotitis. In the former, the
immunomodulating properties of clozapine may sensitize the mononuclear blood
cells, leading to the sialadenitis. The latter hypothesis is the more documented
and proposes that clozapine-induced hypersialorrhea may be responsible for a
chronic inflammatory state that can lead to the formation of a parotid lithiasis
and consequently parotitis. This case report illustrates clozapine
induced-parotitis, a poorly known complication of this compound. Clinicians
should be aware of its hypersialorrhea and inflammatory consequences in order to
better prevent the occurrence of this complication.

Copyright © 2013 L’Encéphale, Paris. Published by Elsevier Masson SAS. All
rights reserved.

DOI: 10.1016/j.encep.2013.04.006
PMID: 23809173 [Indexed for MEDLINE]

Auteurs Bordeaux Neurocampus