Reactions 779 - 27 Nov 1999

★ SClomipramine/sertraline

Acute eosinophilic pneumonia (first report withsertraline): case report

A 40-year-old woman developed acute eosinophilicpneumonia during treatment with sertraline and clomipraminefor depression and anxiety.

The patient presented with nonproductive cough, fever,malaise and progressive dyspnoea on exertion and, for the last4 days, resting dyspnoea. She had been taking sertraline 50mg/day for 1 week, clomipramine 25mg twice daily for 4weeks and alprazolam for 14 months. A chest x-ray showedinfiltrates in both lower lobes and a WBC count of 15 480 cells/ml with 12.2% eosinophils. The woman was admitted tohospital and sertraline was stopped. The results of respiratoryfunction tests were as follows: FVC 1580ml (53.1%); FEV1

1500ml (58.5%); FEV1/FVC 0.94 and maximum mid expiratoryflow 4820ml (137%). Two days later, she developed amorbiliform rash on her trunk, back and legs andclomipramine was stopped. Her liver enzyme levels wereincreased. There was no evidence of parasitic or fungalinfections.

Over the next 5 days, the woman became afebrile, but hereosinophilia persisted (21.9%). She was discharged fromhospital. One month later, she had no dyspnoea and her WBCcount was 6370 cells/ml with 2% eosinophils. She begantreatment with fluoxetine 5 months later. At follow-up, 1 yearlater, she had experienced no relapse.

Author comment: ‘We believe that this is a case of drug-induced AEP [acute eosinophilic pneumonia] because othercauses of pneumonitis were ruled out.’ There was strongevidence to implicate clomipramine and/or sertraline asresponsible for the adverse reaction.Barnes MT, et al. Acute eosinophilic pneumonia associated with antidepressantagents. Pharmacy World and Science 21: 241-242, Oct 1999 - Spain 800804357

» Editorial comment: A search of AdisBase and Medline didnot reveal any previous case reports of pneumonia associatedwith sertraline. However, there has been 1 previous case reportof clomipramine-induced pneumonia.

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Reactions 27 Nov 1999 No. 7790114-9954/10/0779-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved