Myocarditis — MRCPsych Paper B MCQ

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ModerateSchizophrenia & PsychosisMyocarditisMRCPsych Paper B

Three weeks after starting clozapine for treatment-resistant schizophrenia, a patient develops fever, malaise and persistent resting tachycardia. Their serum troponin is raised and the full blood count shows eosinophilia with a normal neutrophil count. Which clozapine-associated adverse effect is most likely?

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Correct answer: C — Myocarditis

The correct answer is C, myocarditis. Clozapine-induced myocarditis occurs predominantly early in treatment, particularly within the first month or two. Fever, malaise and persistent resting tachycardia are characteristic warning features, while raised troponin indicates myocardial injury. Eosinophilia may accompany clozapine-associated myocarditis, although it is not sufficiently reliable as an isolated marker. Agranulocytosis would require marked neutropenia, which is specifically absent. Pneumonia and pulmonary embolism can cause fever or tachycardia, and pulmonary embolism can raise troponin, but the timing after clozapine initiation and eosinophilia favour myocarditis. Neuroleptic malignant syndrome would be supported by severe rigidity, altered consciousness and raised creatine kinase rather than isolated myocardial injury.

Reference: Clozapine Viatris 200 mg Tablets, Summary of Product Characteristics, sections 4.4 and 4.8, revised February 2026. https://www.medicines.org.uk/emc/product/102058/smpc