Abstract
BACKGROUND: Myocarditis is a rare adverse effect of clozapine, often occurring within the first month of use. CASE SUMMARY: We present a case of an 18-year-old woman who developed recurrent somnolence, orthostatic hypotension, and elevated troponins days after starting a clozapine induction, while also on valproic acid. Transthoracic echocardiogram (TTE) revealed a reduced left ventricular ejection fraction and symmetric left ventricular wall thickening concerning for myocardial edema, as well as a pericardial effusion. Clozapine was promptly withdrawn, and the patient was started on colchicine. Follow-up TTE showed improved left ventricular ejection fraction and resolution of left ventricular wall thickening. DISCUSSION: Clozapine-induced myocarditis presents with elevated troponins and inflammatory markers; however, myocardial involvement may not always be detectable by TTE. Medication withdrawal and supportive care are the cornerstone of initial treatment. TAKE-HOME MESSAGE: This case highlights the significant effects that clozapine can have on the myocardium, especially with concurrent use of valproic acid.