Chloroquine neuromyotoxicity. Clinical and pathologic perspective

Estes, Melinda L.; Ewing-Wilson, D.; Chou, S. M.; Mitsumoto, Hiroshi; Hanson, Maurice R.; Shirey, Earl K.; Ratliff, Norman B.

doi:10.1016/0002-9343(87)90444-x

Cited by 177 publications

(91 citation statements)

References 22 publications

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“…In addition, it can be useful for excluding other causes of unexplained cardiomyopathy, such as the aforementioned cardiac manifestations of connective tissue disease 1, 8. An acceptable alternative in patients who are unable to undergo EMB is skeletal muscle biopsy, as CQ/HCQ myopathy can sometimes be identified outside the heart 9. Following diagnosis, immediate cessation of CQ/HCQ and replacement with a non‐cardiotoxic disease‐modifying anti‐rheumatic drug are warranted 5…”

Section: Discussionmentioning

confidence: 99%

Chloroquine‐induced cardiomyopathy: a reversible cause of heart failure

et al. 2018

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Chloroquine (CQ) and hydroxychloroquine (HCQ) are anti‐rheumatic medications frequently used in the treatment of connective tissue disorders. We present the case of a 45‐year‐old woman with CQ‐induced cardiomyopathy leading to severe heart failure. Electrocardiographic abnormalities included bifascicular block, while structural disease consisted of severe biventricular and biatrial hypertrophy. Appropriate diagnosis via endomyocardial biopsy led to cessation of CQ and subsequent dramatic improvement in symptoms and structural heart disease. Cardiac toxicity is an under‐recognized adverse effect of CQ/HCQ leading to cardiomyopathy with concentric hypertrophy and conduction abnormalities, with the potential for significant morbidity and mortality. Predisposing factors for CQ/HCQ‐induced cardiomyopathy have been proposed. CQ/HCQ cardiomyopathy is a phenocopy of Fabry disease, and α‐galactosidase A polymorphism may account for some heterogeneity of disease presentation.

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Section: Discussionmentioning

confidence: 99%

Chloroquine‐induced cardiomyopathy: a reversible cause of heart failure

et al. 2018

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“…22,23 Prognosis in antimalarial cardiotoxicity can vary from death to cardiac transplantation to partial or complete improvement in cardiac function. 5,7,8,10,11,[13][14][15][16][17][18][19][20][24][25][26] Two case reports have described successful orthotopic heart transplantation. 7,10 Indication in both cases was refractory congestive heart failure 3 months after drug discontinuation.…”

Section: Discussionmentioning

confidence: 99%

Hydroxychloroquine cardiotoxicity presenting as a rapidly evolving biventricular cardiomyopathy: key diagnostic features and literature review

Joyce

Fabre

Mahon

2012

European Heart Journal: Acute Cardiovascular Care

140

126

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Cardiotoxicity is a rare but serious complication of hydroxychloroquine, a 4-aminoquinoline increasingly used in the treatment of rheumatological disorders. We describe typical clinical, echocardiographic, and histological features of this rare condition according to the currently available literature, illustrated with a recent new biopsy-proven case of hydroxychloroquine cardiotoxicity in a 52-year-old female with rheumatoid arthritis. Presentation in this case was of a rapidly progressive decompensated biventricular cardiomyopathy associated with recurrent biomarker elevations, conduction system disease, and possibly neuromyotoxicity. Death occurred suddenly 2 months after diagnosis despite drug discontinuation and clinical improvement. The potential role of cardiac magnetic resonance delayed gadolinium enhancement imaging in the prognosis of this toxic cardiomyopathy is also introduced. This case-based literature review highlights that, although rare, hydroxychloroquine cardiotoxicity can be fatal, particularly if irreversible histopathological changes have occurred prior to drug discontinuation. Given this, regular screening with 12-lead electrocardiography and transthoracic echocardiography to detect conduction system disease and/or biventricular morphological or functional changes should be considered in hydroxychloroquine-treated patients in addition to recommended ophthalmological screening.

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“…Fortunately, the muscle pathologic features of these different etiologies are distinct. Hydroxychloroquine myopathy shows myofiber necrosis and autophagic vacuoles, as shown in this case, steroid myopathy is marked by type IIb fiber atrophy, and inflammatory myopathy shows primary inflammation [12]. It is important to make a definitive diagnosis because the management in all three cases would be different.…”

Section: Discussionmentioning

confidence: 78%

“…Vacuolar myopathy has been reported in association with amphiphilic drugs including hydroxychloroquine and its precursor drug, chloroquine [11][12][13]. Once administered, hydroxychloroquine is widely distributed in the body, including the skeletal and cardiac muscles [14,15].…”

Section: Discussionmentioning

confidence: 99%

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Hydroxychloroquine causes severe vacuolar myopathy in a patient with chronic graft‐versus‐host disease

et al. 2005

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A 51-year-old man developed progressive debilitating limb and respiratory muscle weakness while undergoing treatment for chronic graft-versus-host disease secondary to allogeneic bone marrow transplant for mantle cell lymphoma. He had a normal serum creatine kinase level and acetylcholine receptor antibodies were negative. Electromyography showed a severe, nonirritable myopathy and a sensory motor axonal polyneuropathy. A muscle biopsy showed a necrotizing, vacuolar myopathy with many fibers containing autophagic and red-rimmed vacuoles, suggestive of an amphiphilic drug myopathy. The patient's strength and function improved significantly after discontinuation of hydroxychloroquine. Am.

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Chloroquine neuromyotoxicity. Clinical and pathologic perspective

Cited by 177 publications

References 22 publications

Chloroquine‐induced cardiomyopathy: a reversible cause of heart failure

Chloroquine‐induced cardiomyopathy: a reversible cause of heart failure

Hydroxychloroquine cardiotoxicity presenting as a rapidly evolving biventricular cardiomyopathy: key diagnostic features and literature review

Hydroxychloroquine causes severe vacuolar myopathy in a patient with chronic graft‐versus‐host disease

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