RESUMEN
We herein report a 76-year-old woman with situs inversus and dextrocardia who underwent pacemaker implantation for sick sinus syndrome. Situs inversus with dextrocardia, which is frequently associated with cardiovascular malformation, is a rare congenital malformation wherein the thoracic and abdominal viscera are inverted compared with their normal positions. This renders the implantation of cardiac devices an arduous task. We therefore decided to gather preoperative anatomical information on patients with situs inversus and dextrocardia. We used three-dimensional computed tomography to collect preoperative information in order to facilitate the safe implantation of cardiac devices.
RESUMEN
BACKGROUND: Clozapine use is complicated by an increased risk of hematological adverse effects such as neutropenia and, rarely, eosinophilia. CASE PRESENTATION: We present the case of a 48-year-old man with treatment-resistant schizophrenia. On day 12 after clozapine initiation, he had a cough with a temperature of 39.8°C. On day 16, his leukocyte count had increased to 9320 cells/mm3 (neutrophils 7550 cells/mm3 and eosinophils 680 cells/mm3 ). We discontinued lithium because of neutrophilia and damage to renal function on day 20. His eosinophil count increased until day 29, reaching 6750 cells/mm3 . We suspected a drug-induced reaction and discontinued clozapine on day 30. His eosinophil count gradually decreased, reaching the normal range by day 40. However, his leukocyte and neutrophil counts also gradually decreased to below than the normal range by day 40. His leukocytes and neutrophil counts had recovered by day 55. CONCLUSION: We concluded that this patient had clozapine-associated severe eosinophilia following lithium rebound neutropenia.
