Case reportHeart transplantation in a patient with chloroquine-induced cardiomyopathy☆
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
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Cited by (21)
Cardiovascular Disease in Rheumatoid Arthritis
2014, Rheumatic Disease Clinics of North AmericaCitation 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 VenereologieComplete atrioventricular block following long term treatment with chloroquine
2008, Revue de Medecine Interne28 Antiprotozoal drugs
2007, Side Effects of Drugs AnnualAmerican College of Rheumatology White Paper on Antimalarial Cardiac Toxicity
2021, Arthritis and Rheumatology
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Support by the Robert Donald Van Kampen Heart Transplant Resource Center.