Beyond Expectations: A Case of Doxorubicin-Induced Cardiomyopathy at a Remarkably Low Cumulative Dose

Anthracycline and its associated cardiotoxicity have been well-established in the literature. With decades of use of anthracycline for a variety of cancer treatments and increased cancer survivability, a detailed study on its cardiac effects is in the continuum. Higher doses of anthracyclines were previously considered the only responsible factor for cardiomyopathy, leading to congestive heart failure. These concepts are now gradually changing to subclinical cardiac changes that even occur at a dosage of 450 mg/m² or less, which was considered safe previously. Here, we present a case of a 64-year-old patient who was started on doxorubicin and then developed subclinical cardiomyopathy at a surprisingly low cumulative dose of 113 mg/m². Hence, this case highlights the importance of exploring risk factors, establishing investigations to pick up early changes, and reconsidering a safe dose of anthracycline on a case-to-case basis.