{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:52:36Z","timestamp":1786978356005,"version":"build-2736575974"},"reference-count":11,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,3,2]],"date-time":"2025-03-02T00:00:00Z","timestamp":1740873600000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["PCN Reports"],"published-print":{"date-parts":[[2025,3]]},"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n \n Clozapine\u2010induced agranulocytosis (CLIA) is a rare but serious complication. Fever associated with CLIA is typically treated with broad\u2010spectrum antimicrobials, but empiric antifungal therapy is rarely used. While bacterial and viral infections have been reported in CLIA cases, no cases of fungal infections complicated by CLIA have been documented. We report the first case of CLIA complicated by invasive pulmonary aspergillosis (IPA) in a patient with schizophrenia. The diagnosis of IPA was made using serum \u03b2\u2010D\u2010glucan,\n Aspergillus<\/jats:italic>\n galactomannan antigen tests, and chest computed tomography (CT).\n <\/jats:p>\n <\/jats:sec>\n \n Case presentation<\/jats:title>\n \n We present a case of a 51\u2010year\u2010old man with schizophrenia who developed CLIA complicated by IPA. The patient, diagnosed with treatment\u2010resistant schizophrenia, was started on clozapine, but 9 months later he presented with fever, cough, leukopenia, and neutropenia. Clozapine was discontinued, and empirical treatments with cefepime and filgrastim were initiated. Serum \u03b2\u2010D\u2010glucan and\n Aspergillus<\/jats:italic>\n galactomannan antigen tests were positive, and chest CT showed well\u2010circumscribed nodules, leading to a probable diagnosis of IPA. Antifungal therapy was switched from micafungin to voriconazole according to guidelines. His neutropenia and fever improved, and he was re\u2010transferred to a psychiatric hospital.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n \n CLIA can be complicated by fungal infections. When patients with CLIA present with fever, fungal infections, including IPA, should be considered in the differential diagnosis. Serological tests, including \u03b2\u2010D\u2010glucan and\n Aspergillus<\/jats:italic>\n galactomannan, are useful for the diagnosis of IPA as well as the appropriate use of antifungal agents in patients with CLIA.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/pcn5.70077","type":"journal-article","created":{"date-parts":[[2025,3,3]],"date-time":"2025-03-03T06:42:51Z","timestamp":1740984171000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["A case of invasive pulmonary aspergillosis associated with clozapine\u2010induced agranulocytosis"],"prefix":"10.1002","volume":"4","author":[{"given":"Akiyoshi","family":"Yokode","sequence":"first","affiliation":[{"name":"Department of Neuropsychiatry Okayama University Hospital Okayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6181-3166","authenticated-orcid":false,"given":"Masaki","family":"Fujiwara","sequence":"additional","affiliation":[{"name":"Department of Neuropsychiatry Okayama University Hospital Okayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6728-3346","authenticated-orcid":false,"given":"Toshiki","family":"Terao","sequence":"additional","affiliation":[{"name":"Department of Hematology and Oncology Okayama University Hospital Okayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinji","family":"Sakamoto","sequence":"additional","affiliation":[{"name":"Department of Neuropsychiatry Okayama University Hospital Okayama 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Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,3,2]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291719000369"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199307153290303"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciw326"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-0691.1998.tb00046.x"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2007-979335"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciz1008"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/hup.2739"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/ejh.12641"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2013-203618"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.11m07244"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.3390\/ph13120439"}],"container-title":["Psychiatry and Clinical Neurosciences Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pcn5.70077","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,29]],"date-time":"2025-03-29T00:30:42Z","timestamp":1743208242000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/pcn5.70077"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3]]},"references-count":11,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,3]]}},"alternative-id":["10.1002\/pcn5.70077"],"URL":"https:\/\/doi.org\/10.1002\/pcn5.70077","archive":["Portico"],"relation":{},"ISSN":["2769-2558","2769-2558"],"issn-type":[{"value":"2769-2558","type":"print"},{"value":"2769-2558","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3]]},"assertion":[{"value":"2024-10-04","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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