Reversible Dilated Cardiomyopathy in a Male Patient With Rheumatoid Arthritis: A Case Report.

Area of Science:

• Cardiology
• Rheumatology
• Pharmacology

Background:

• A 65-year-old male with rheumatoid arthritis (RA) on rituximab and hydroxychloroquine (HCQ) presented with acute heart failure.
• The patient had no prior cardiac history but developed severe left ventricular dysfunction.

Observation:

• Diagnosis of dilated cardiomyopathy (DCM) with severely reduced ejection fraction (10-15%) and new left bundle branch block.
• Coronary angiography ruled out coronary artery disease; other common DCM causes were excluded.

Findings:

• Discontinuation of rituximab and HCQ led to significant improvement in left ventricular ejection fraction (LVEF) to 55% over 26 months.
• Rheumatoid arthritis progression necessitated switching to tocilizumab, which was well-tolerated.

Implications:

• This case suggests a potential link between rituximab/HCQ and drug-induced DCM, emphasizing the need for cardiac monitoring in RA patients.
• Physicians must consider potential cardiovascular side effects of immunosuppressive therapies and collaborate on patient management.