Severe Anemia: A Case Report of an Uncommon Precipitant of Schizophrenia Relapse

Abstract

A 48-year-old patient with stable residual schizophrenia experienced a syndromic psychosis relapse following an episode of severe combined immunohemolytic and pure red cell aplastic anemia, with a hemoglobin level of 4.7 g/dl. The anemia was attributed to her anti-HIV medication zidovudine. Her HIV infection had been well-controlled; no other organic precipitant of the psychosis was found. Following transfusion of 2 units of leukocyte-poor packed red cells, schizophrenia symptoms promptly recovered to her baseline. This was maintained at 3-and 6-month follow-ups without any need for antipsychotic dose adjustment. Following zidovudine discontinuation and a short course of oral prednisolone, her anemia gradually recovered.