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RAPID ONSET HYDROXYCHLOROQUINE TOXICITY.

Brida M Jeltsch1, David Sarraf2, Darius Madjdpour3

  • 1University Hospital Zürich, University of Zürich, Zürich, Switzerland.

Retinal Cases & Brief Reports
|March 1, 2023
PubMed
Summary
This summary is machine-generated.

Hydroxychloroquine (HCQ) retinopathy can develop rapidly, even within two years of treatment. This case highlights the need for strict adherence to dosing guidelines and potentially enhanced screening to prevent severe vision loss from HCQ toxicity.

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Area of Science:

  • Ophthalmology
  • Rheumatology
  • Toxicology

Background:

  • Hydroxychloroquine (HCQ) is commonly prescribed for autoimmune conditions like rheumatoid arthritis.
  • Long-term HCQ use is associated with irreversible retinal damage, necessitating monitoring.
  • The American Academy of Ophthalmology provides guidelines for HCQ dosing and screening to mitigate ocular toxicity.

Observation:

  • A 58-year-old woman developed severe, rapidly progressing retinopathy after two years of HCQ treatment.
  • Her daily HCQ dosage escalated to 7.2 mg/kg, exceeding recommended guidelines.
  • Symptoms included severe concentric visual field constriction, indicating significant retinal degeneration.

Findings:

  • The patient exhibited rapid-onset, severe panretinal degeneration despite a relatively short treatment duration.
  • Diagnostic tests, including OCT and electroretinography, confirmed extensive retinal damage.
  • Ancillary tests ruled out other causes of degeneration, implicating HCQ toxicity.

Implications:

  • This case underscores the risk of rapid HCQ-associated retinopathy, even at doses approaching recommended limits.
  • It suggests that individual susceptibility factors may influence the onset and severity of HCQ toxicity.
  • There may be a need for supplementary screening methods beyond current recommendations to detect early signs of HCQ retinopathy.
  • Strict adherence to the American Academy of Ophthalmology's dosing guideline of 5 mg/kg is crucial to prevent severe visual impairment.