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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.
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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
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Figure B: Coronary angiogram showing normal Left and Right coronary arteries
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Figure C: TTE showing normal LV size and LV thrombus (Yellow arrow)
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Figure D: Light microscopy (Hematoxylin and eosin stain with magnification x 40) of endomyocardial biopsy showing myocyte vacuolization
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Figure E: Light microscopy (hematoxylin and eosin stain with magnification x 100) of endomyocardial biopsy showing myocyte vacuolization