Psychiatrymiddle twist
A 24-year-old man with schizophrenia has been taking clozapine for 17 days, titrated to 250 mg daily after two other antipsychotics failed. He reports three days of tiredness and mild central chest discomfort. His temperature is 38.1 °C, heart rate 122 beats per minute and blood pressure 105/65 mmHg. The chest is clear, oxygen saturation is 98% breathing room air and the calves are not tender. He is fully oriented, has no rigidity, and his neutrophil count and creatine kinase are normal. Troponin and C-reactive protein are both rising. Which one of the following complications of clozapine does this pattern indicate?