Atypical Case of Minoxidil-Induced Generalized Anasarca and Pleuropericardial Effusion

Abstract

Minoxidil is an antihypertensive medication used to control blood pressure that is resistant to three or more antihypertensive medications including diuretics. There have only been a few reported cases of minoxidilinduced pleuropericardial effusion with anasarca. Here, we discuss the case of a 70-year-old male with a history of uncontrolled hypertension who presented to the hospital with swelling of the extremities. He was on minoxidil 10 mg twice a day and complained of generalized body swelling and extremity pain with symptoms of dyspnea on exertion, paroxysmal nocturnal dyspnea, weight gain, abdominal distention, and intermittent, throbbing extremity pain (8/10). The patient denied a history of cardiac disease, pulmonary embolism, deep vein thrombosis, and malignancy. His vitals were stable with a blood pressure of 152/67 mmHg. The physical examination findings were significant for positive jugular vein pressure, bilateral crackles at the lung bases with abdominal distention, fluid thrill, and flank edema. The extremities showed pitting edema in the upper and lower extremities that were tender to palpation. Laboratory results were only significant for uremia and elevated brain natriuretic peptide. Electrocardiography, echocardiography, and CT of the chest and abdomen exhibited findings consistent with pericardial effusion, pleural effusion, abdominal ascites, and anasarca in the soft tissues of the axilla and chest wall. After discontinuation of minoxidil and starting intravenous diuretics, the patient showed clinical improvement. This case report reviews and explains that minoxidil-induced anasarca should be considered as a differential diagnosis in patients taking minoxidil as knowledge of this rare finding may lead to early diagnosis and management.

Minoxidil-associated pericardial effusion and impending tamponade

“…4 Minoxidil-induced pericardial effusions are more likely in patients with fluid overload, such as those with renal disease or heart failure, although it also has been found in patients with no comorbid conditions. [4][5][6][7][8][9] The case patient had risk factors for the development of a pericardial effusion, including ESRD requiring hemodialysis. Patients on hemodialysis who also are taking minoxidil have a sig-nificantly higher incidence of pericardial effusion compared with patients on hemodialysis alone.…”

Minoxidil Associated Pleural and Pericardial Effusion in Patient on Hemodialysis

“…In the past, drugs like procainamide, hydralazine, and isoniazid caused drug-induced lupus and associated serositis. But recently, cardiac toxicity, including pericarditis, has been recognized as a side-effect of checkpoint inhibitors such as ipilimumab and nivolumab [2,8].…”

Low-Dose Oral Minoxidil for Alopecia: A Comprehensive Review

“…CVS symptoms refer to a group of side effects that include hypotension, edema, premature ventricular contractions, fatigue, tachycardia, and ECG changes [2-6, 9, 10]. Very few patients have been reported to develop type B idiosyncratic reactions: pericardial effusion and generalized anasarca [40][41][42][43][44].…”