Bruton Tyrosine Kinase Inhibitor Ibrutinib and Pericardial Tamponade: A Case Report

Ibrutinib is a Bruton's tyrosine kinase (BTK) inhibitor widely used in the treatment of B-cell malignancies, including chronic lymphocytic leukemia (CLL). While effective, it is associated with cardiovascular adverse events, most commonly atrial fibrillation (AF) and hypertension. Pericardial complications, such as pericardial effusion and cardiac tamponade, are extremely rare. We report the case of a 66-year-old woman with CLL treated with ibrutinib who presented with progressive dyspnea, signs of peripheral hypoperfusion, and a new-onset episode of AF. Point-of-care echocardiography revealed a large pericardial effusion with features of cardiac tamponade, requiring urgent pericardiocentesis, with hemodynamic stabilization. Ibrutinib was discontinued due to clinical concern for a possible drug-related serosal reaction, followed by complete resolution of pericardial and pleural effusions and sustained clinical improvement. This case highlights a rare but potentially life-threatening complication that may be associated with ibrutinib therapy. Clinicians should maintain a high index of suspicion for cardiac tamponade in patients receiving BTK inhibitors who present with nonspecific cardiopulmonary symptoms. Prompt echocardiographic evaluation and individualized management decisions, including drug discontinuation, are key to achieving favorable outcomes.