Advances in chemotherapy and radiotherapy have had the greatest impact on cancer survival, but their combined side effects have led patients to deal with serious organic complications as a result of their treatment. In attempting to treat the cancer, many times anti-cancer therapies cause complications that need treatment themselves. Frequently, use of these agents in combination will result in the addition of toxicities and can exponentially increase their side-effect profile. Even whilst these drugs are used within therapeutic dose ranges they can cause toxicities. They need not be dosed excessively in order to cause complications. The most common side effects of anticancer chemotherapeutic agents (CCAs) are nausea, vomiting, hair loss, stomatitis, and leukopenia [1].Another major toxicity seen with some agents is cardiotoxicity. Although cardiotoxicity is less common than the gastrointestinal disturbances, it can occur particularly with the use of the anthracycline agents doxorubicin and daunorubicin [2].In addition to the anthracyclines, two other CCAs have been implicated in causing cardiotoxicity: melphalan and fludarabine. Melphalan is an alkylating agent that has been reported to cause paroxysmal arrhythmias and fludarabine is a purine analog that has rarely been associated with cardiac dysfunction [3]. These therapies have been used in combination to treat multiple myeloma, chronic lymphocytic leukemia (CLL), chronic myeloid leukemia, acute lymphoblastic leukemia, non-Hodgkin lymphoma, acute myeloblastic leukemia, and paroxysmal nocturnal hemoglobinemia and have been well tolerated. Individually these agents do not typically cause cardiotoxicity however in combination the risk increases resulting in a greater potential for heart failure. We present a case of myocarditis with persistent systolic heart failure associated with these medications. Case reportA 48-year old woman with an 8-year history of refractory mycosis fungoides underwent chemotherapy and an allogenic