Non hemorrhagic pericardial effusion from ibrutinib İn a patient without comorbidities

Abstract

Introduction The most common kind of leukemia in adults is chronic lymphocytic leukemia (CLL). CLL is treated with ibrutinib. During the course of ibrutinib therapy, bleeding and cardiac arrhythmias may occur. Non-hemorrhagic adverse events are extremely infrequent in individuals using ibrutinib. Case report A 64 year-old man was diagnosed with CLL in June 2016. He was treated with 6 courses of FCR, he stayed in remission for 3 years and then relapsed. He achieved partial remission after two months of therapy with ibrutinib. The patient was admitted to the hospital with fever and shortness of breath. Pericardial tamponade and effusion was diagnosed during his evaluation. Management & outcome Non-hemorrhagic exudative effusion was drained by pericardiocentesis and a pericardial catheter was inserted to drain pericardial effusion. In all pleural and pericardial effusion samples, pathological and flow cytometric examination revealed no atypical malignant cells for malignancy, including CLL. Infections, both bacterial and viral, were also undetectable in the samples, as were rheumatological markers of collagen vascular disease. Ibrutinib therapy was discontinued. The pericardial effusion and tamponade were linked to ibrutinib treatment after evaluating the adverse drug reaction probability scale with a total score of 6. Colchicine was administered to reduce the pericardial effusion. The catheter was removed; pericardial effusion did not reoccur during follow up visits. Discussion Serious adverse events of ibrutinib are seen when treating CLL patients. This group of individuals should be closely monitored for potentially serious complications such as pericardial effusion and cardiac tamponade.

Pericarditis and Cardiac Tamponade in Patients Treated with First and Second Generation Bruton Tyrosine Kinase Inhibitors: An Underappreciated Risk

“…The occurrence of pericarditis and pericardial effusions with ibrutinib has previously been recognized; however, most of the current literature is limited to case reports [ 4 , 7 , 10 , 11 ]. A larger meta-analysis of cardiovascular events reported a small risk of pericardial effusions (0.5%) and pericarditis (0.4%) [ 12 ].…”

“…Pericardial effusions in cancer patients can have a multifactorial etiology ( Figure 1 ), attributable to direct neoplastic invasion of the pericardium, hemorrhage, the effects of chemotherapy or radiotherapy, or concurrent infections [ 5 ]. Pericarditis and pericardial effusions are infrequently observed in patients treated with ibrutinib [ 6 , 7 ]. Without prompt and appropriate management, pericarditis can progress to cardiac tamponade [ 8 ].…”