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Chloroquine-induced cardiomyopathy
Insights
Chloroquine phosphate treatment for systemic lupus erythematosus can cause biventricular hypertrophy and failure. Myocardial deposits in patients indicate chloroquine-induced cardiotoxicity, necessitating clinical awareness and biopsy for diagnosis.
Area of Science:
- Cardiology
- Toxicology
- Rheumatology
Background:
- Systemic lupus erythematosus (SLE) is an autoimmune disease with potential cardiovascular manifestations.
- Chloroquine phosphate is a medication used to treat SLE and other conditions.
- Cardiotoxicity is a known potential side effect of certain medications.
Observation:
- Two patients with SLE developed biventricular hypertrophy and failure during chloroquine phosphate treatment.
- Morphologic analysis of cardiac tissue revealed electron-dense lamellar and curvilinear bodies within myocytes.
- These myocardial deposits resemble those seen in chloroquine-induced skeletal myopathy.
Findings:
- The observed myocardial changes are consistent with chloroquine-induced cardiotoxicity.
- The findings suggest the cardiac issues were drug-induced rather than a direct manifestation of SLE.
- Endomyocardial biopsy is crucial for identifying these specific drug-induced cardiac changes.
Implications:
- Clinical awareness of chloroquine cardiotoxicity is essential for patients on this medication.
- Early diagnosis through endomyocardial biopsy can prevent further cardiac damage.
- This study highlights the importance of monitoring cardiac function in patients receiving chloroquine phosphate.
Abstract:
Biventricular hypertrophy and failure developed in two patients during treatment of systemic lupus erythematosus with chloroquine phosphate. In both patients, morphologic analysis of the myocardium, obtained by a right ventricular endomyocardial biopsy in one patient and at autopsy in the other, revealed accumulations of electron-dense concentric and parallel lamellae and curvilinear bodies within cardiac myocytes. These deposits were similar to those reported in chloroquine-induced skeletal myopathy and were considered to represent evidence of chloroquine-induced cardiotoxicity rather than a cardiovascular manifestation of the underlying disease. Clinical awareness and an endomyocardial biopsy specimen are necessary for the appropriate diagnosis of chloroquine-induced cardiomyopathy.