Coronary Microvascular Dysfunction Related to Hydroxychloroquine-Induced Cardiomyopathy

A 69-year-old woman with seropositive rheumatoid arthritis presented with subacute worsening of her chronic chest pain.

Cardiac magnetic resonance demonstrated new diffuse edema, patchy late gadolinium enhancement, and a reduction in myocardial perfusion reserve index, which raised concern for an infiltrative cardiomyopathy leading to microvascular dysfunction. An endomyocardial biopsy resulted in a rare diagnosis of drug-induced cardiomyopathy.

We report a new association between this drug toxicity and coronary microvascular disease. This represents not only a new finding but potential expanded understanding of the pathophysiology of this disease condition. This finding could have implications for both diagnostic testing and disease management.

This case establishes a new relationship between hydroxychloroquine cardiomyopathy and microvascular dysfunction. In addition to the cytotoxic effects of hydroxychloroquine, there may be an additional mechanism of vascular injury leading to the known manifestations with various electrical disturbances, and myocardial dysfunction.