Case report
Heart transplantation in a patient with chloroquine-induced cardiomyopathy

https://doi.org/10.1016/S1053-2498(03)00108-6Get rights and content

Abstract

We present the first report of a patient who underwent heart transplantation (HT) after endomyocardial biopsy (EMB) and revealed chloroquine-induced cardiomyopathy (CIC). This patient, who was treated with chloroquine for 6 years, developed a restrictive cardiomyopathy that progressed to congestive heart failure (CHF) resistant to medical management.

Section snippets

Case report

A 50-year-old woman with rheumatoid arthritis and unstable congestive heart failure (CHF) was transferred to our hospital for treatment of heart failure and evaluation for possible heart transplantation (HT). She had an 18-year history of rheumatoid arthritis (rheumatoid factor-positive) with moderate, but not lifestyle-limiting, joint deformities treated weekly with methotrexate and the addition of 500 mg/d chloroquine for the last 6 years, which had been discontinued 1 month before transfer.

Discussion

We believe this is the first report of a patient with CIC to receive HT. Our patient received 500 mg/d for 6 years with a cumulative dose of 1,100 g. This dose is consistent with a report of patients receiving 600 to 2,280 g of chloroquine who developed cardiomyopathy due to toxicity from either high doses or prolonged treatment.4

Acute chloroquine toxicity can cause fatal arrhythmias due to interference with mitochondrial oxidative metabolism.7 The 2 known explanations for chronic chloroquine

References (8)

  • C. August et al.

    Histological and ultrastructural findings in chloroquine-induced cardiomyopathy

    J Mol Med

    (1995)
  • G.I. Cubero et al.

    Restrictive cardiomyopathy caused by chloroquine

    Br Heart J

    (1993)
  • H.A. McAllister et al.

    Chloroquine induced cardiomyopathy

    Arch Pathol Lab Med

    (1987)
  • A. Cervera et al.

    Cardiac toxicity secondary to long term treatment with chloroquine

    Ann Rheum Dis

    (2001)
There are more references available in the full text version of this article.

Cited by (21)

  • Cardiovascular Disease in Rheumatoid Arthritis

    2014, Rheumatic Disease Clinics of North America
    Citation Excerpt :

    Withdrawal of the medication resulted in stabilization in some cases (8/12 patients). There are case reports of patients who have required heart transplantation after antimalarial cardiotoxicity.44 Cardiomyopathy has also occurred with TNF-I. Although symptomatic heart failure is a contraindication to use of TNF- I, the risk of heart failure associated with anti-TNF agents is a controversial topic.

  • Chloroquine cardiotoxicity in long-term lupus therapy in two patients

    2009, Annales de Dermatologie et de Venereologie
  • 28 Antiprotozoal drugs

    2007, Side Effects of Drugs Annual
View all citing articles on Scopus

Support by the Robert Donald Van Kampen Heart Transplant Resource Center.

View full text