Author ORCID Identifier
0000-0002-2087-0877
Abstract
Hydroxychloroquine (HCQ) is one of the immunomodulatory medications used in treatment of autoimmune diseases. Rarely, HCQ can cause serious complications, such as cardiotoxicity. We present a rare case of HCQ-induced cardiomyopathy. 60-year-old female patient with a medical history of SLE on chronic HCQ therapy for 28 years, preexisting non-ischemic cardiomyopathy and heart failure with reduced ejection fraction for 7 years, and complete heart block status post pacemaker insertion presented with acute chest pain and severe weight loss. Patient underwent coronary angiogram that showed normal coronaries and right-sided heart catheterization that showed acute heart failure. Echocardiogram showed LVEF of 30% with global hypokinesis. Patient was started on dobutamine with an improvement of her symptoms. As HCQ-induced cardiomyopathy was suspected, patient underwent an endomyocardial biopsy that revealed a pathognomonic finding of myocyte vacuolization, consistent with HCQ-induced cardiomyopathy. HCQ was discontinued immediately. However, patient was a poor candidate for heart transplantation and durable mechanical circulatory support due to severe malnutrition secondary to end-stage heart failure. Patient accepted hospice care and passed away peacefully. This case highlights the need for high index of clinical suspicion, careful medication reconciliation for patients with non-ischemic cardiomyopathy, and tissue biopsy with careful histopathological examination to diagnose this rare complication.
Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License
Recommended Citation
Mohamed M, Wojciechowski K, Feitell S, Osama M, Hashem A, Patel J, Mahmoud A, Abdelhay A, Upreti P, Khodjaev S. Hydroxychloroquine Induced Cardiomyopathy. Advances in Clinical Medical Research and Healthcare Delivery. 2023; 3(3). doi: 10.53785/2769-2779.1165.
Figure A: EKG showing no concerning changes for acute myocardial ischemia
Figure B.png (80 kB)
Figure B: Coronary angiogram showing normal Left and Right coronary arteries
Figure C.jpg (97 kB)
Figure C: TTE showing normal LV size and LV thrombus (Yellow arrow)
Figure D.png (1335 kB)
Figure D: Light microscopy (Hematoxylin and eosin stain with magnification x 40) of endomyocardial biopsy showing myocyte vacuolization
Figure E. png.png (1496 kB)
Figure E: Light microscopy (hematoxylin and eosin stain with magnification x 100) of endomyocardial biopsy showing myocyte vacuolization
Publisher Note
All articles published in ACMRHD are distributed with a Creative Commons CC BY-NC 4.0 license. Under this license, authors hold the copyright to their work and have the right to share or adapt the article with no restrictions, as long as the author(s) and source are cited, and the use is for noncommercial purposes. This policy went into effect November 1, 2023, and applies retroactively to all articles published in ACMRHD prior to that date, as well.
Included in
Cardiology Commons, Internal Medicine Commons, Rheumatology Commons