Hydroxychloraquine-Induced Acute Psychotic Disorder in a Female Patient with Rheumatoid Arthritis: a Case Report/Romatoid artriti olan kadin hastada hidroksiklorokin kullanimina bagli gelisen akut psikotik bozukluk: Olgu sunumu

Headnote

ABSTRACT

Hydroxychloraquine-induced acute psychotic disorder in a female patient with rheumatoid arthritis: a case report

Chloroquine and its derivative hydroxychloroquine (HCQ) have been used for acute and prophilactic treatment of malaria for most of the last century. HCQ has anti-inflammatory, antilipidemic and antithrombotic effects and in recent years has become an important drug for treating rheumatoid arthritis (RA). In the literature, antimalarial-induced psychosis has been reported in a small number of cases; however, we did not find any case related with HCQ-induced psychosis in rheumatoid arthritis. We want to report a 73-year-old female RA patient without a previous history of psychosis who developed psychosis after use of HCQ. HCQ is being increasingly prescribed in autoimmune diseases. Clinicians need to be aware of psychosis as a rare but debilitating side effect.

Keywords: Hydroxychloroquine, psychosis, side-effect

ÖZET

Romatoid artriti olan kadin hastada hidroksiklorokin kullanimina bagli gelisen akut psikotik bozukluk: Olgu sunumu

Klorokin ve ondan sentez edilen hidroksiklorokin (HCQ) sitmanin akut ve idame tedavisinde son yüzyilda yaygin olarak kullanilmaktadir. HCQ'nin antiinflamatuvar, antilipidemik ve antitrombotik etkileri vardir ve son yillarda romatoid artrit tedavisinde önemli hale gelmistir. Yazinda antimalaryal kullanimina bagli psikoz birkaç vaka sunumunda bildirilmis fakat romatoid artritte HCQ kullanimina bagli bir olguya rastlanmamistir. Bu olgu sunumunda psikoz öyküsü olmayan 73 yasinda RA'i olan yasli kadin hastada HCQ kullanimina bagli gelisen psikoz vakasini sunduk. HCQ otoimmün hastaliklarin tedavisinde yaygin olarak reçete edilmeye baslanmistir. Klinisyenlerin nadir ancak islevselligi bozan bir yan etki olan psikoz konusunda uyanik olmalari gerekmektedir.

Anahtar kelimeler: Hidroksiklorokin, psikoz, yan etki

INTRODUCTION

Besides acute and maintenance treatment of malaria, 4-Aminoquinolones (chloroquine and hydroxychloroquine) are also frequently used for the treatment of immune diseases such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), as well as extraintestinal amebiasis. Absence of serious adverse events other than on the field of vision, presence of antithrombic and antilipidemic efficacy in addition to anti-inflammatory efficacy, being cheap and well tolerated compared to the other drugs, and a fast onset of action are the main reasons for preferring these drugs (1,2). Despite widespread usage in regions where malaria is endemic, toxic dose range and mental and behavioral side effects of these drugs are not known definitely.

Maximum plasma concentration after single dose is reached in one to two hours, its...