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Penicillamine-induced polymyositis with complete heart block
P D Christensen1, K E Sørensen
1University Department of Cardiology, Skejby Hospital, Aarhus, Denmark.
European Heart Journal
|November 1, 1989
Summary
Penicillamine treatment for rheumatoid arthritis can cause severe polymyositis and heart block. Fortunately, these effects may be reversible after drug withdrawal, highlighting the need for cardiac monitoring.
Area of Science:
- Rheumatology
- Cardiology
- Toxicology
Background:
- Rheumatoid arthritis (RA) is a chronic autoimmune disease.
- Penicillamine is a chelating agent used to treat RA.
- Drug-induced side effects can manifest in various organ systems.
Observation:
- A 69-year-old male patient developed complete heart block with severe Adams-Stokes attacks and polymyositis.
- These symptoms emerged after six weeks of penicillamine treatment for suspected RA.
- The patient's condition significantly improved upon discontinuation of the drug.
Findings:
- Muscle enzymes and cardiac rhythm normalized after penicillamine withdrawal.
- A persistent right bundle branch block was the only residual cardiac abnormality.
- This case suggests that severe cardiac damage from penicillamine-induced polymyositis can be reversible.
Implications:
- Close cardiac monitoring is crucial for patients with penicillamine-induced polymyositis.
- Early detection and drug withdrawal can lead to recovery of cardiac function.
- This emphasizes the importance of recognizing drug-induced cardiotoxicity in rheumatological practice.
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