When the Tumor Leaves but the Damage Lingers: A Case of Delayed Cardiomyopathy Recovery Post-Paraganglioma Resection

Catecholamine-induced cardiomyopathy secondary to paraganglioma is a rare and potentially reversible condition. However, the course of recovery post-resection remains variable and may be delayed despite biochemical cure. We present the case of a 47-year-old male with biopsy-confirmed extra-adrenal paraganglioma who developed acute decompensated heart failure due to catecholamine-induced cardiomyopathy (left ventricular ejection fraction (LVEF) 30-35%) and multiorgan dysfunction. Despite successful surgical resection, his LVEF remained reduced postoperatively, and he was discharged on heart failure therapy and a wearable cardioverter defibrillator. A follow-up echocardiogram showed improvement in LVEF to 45% 2 weeks later, but his blood pressure remained poorly controlled despite adherence to a multi-drug regimen and lifestyle measures. He was readmitted with a transient ischemic attack (TIA) shortly after surgery. This case illustrates the variable recovery trajectory in paraganglioma-induced cardiomyopathy and highlights persistent cardiovascular risks, including resistant hypertension and cerebrovascular events despite biochemical cure. It emphasizes the importance of ongoing cardiac surveillance and multidisciplinary management, particularly in patients facing socioeconomic barriers to follow-up care.