Huntington’s disease (HD) is an autosomal dominant neurodegenerative
disease. Its clinical presentation is primarily characterized by
motor dysfunction, cognitive decline, and a broad spectrum of
neuropsychiatric symptoms. Common psychiatric manifestations
of HD include mood and anxiety disorders as well as behavioral and
personality changes. Psychosis is relatively rare. Clozapine may be used
for HD with psychosis because of its low extrapyramidal side effect
profile. However, clozapine administration has been associated with
rare but potentially fatal adverse effects, such as agranulocytosis and
myocarditis. Clozapine-induced myocarditis is a severe complication
that typically emerges within the first weeks of treatment and can lead
to cardiovascular collapse if not recognized early. Although cardiac
autonomic dysregulation and basal cardiac stress induced by mutant
huntingtin (mHTT) protein accumulation are recognized in patients
with Huntington’s disease (HD), data regarding clozapine toxicity
within this specific context remain limited. This case report presents
a 51-year-old male patient who developed acute myocarditis during
clozapine treatment initiated for psychotic symptoms arising in the
context of HD. Following the discontinuation of clozapine, the patient
was referred for cardiological monitoring. Throughout this paper, we
will discuss the diagnostic process of myocarditis—a rare but potentially
life-threatening complication of clozapine—and potential contributing
factors. This case highlights the vital importance of early cardiac
monitoring during clozapine use, particularly in psychiatric conditions
accompanied by neurodegenerative processes.
Keywords: Case report, chorea, clozapine, Huntington’s disease,
myocarditis, psychosis