Nord Jessica E, Shah Prediman K, Rinaldi Renee Z, Weisman Michael H
Department of Psychiatry and Biobehavioral Sciences, UCLA Neuropsychiatric Institute, Los Angeles, California, USA.
Semin Arthritis Rheum. 2004 Apr;33(5):336-51. doi: 10.1016/j.semarthrit.2003.09.012.
Hydroxychloroquine (HCQ) is extensively used in the long-term treatment of systemic lupus erythematosus (SLE). Although considered by clinicians to be relatively safe, serious side effects have been documented in the literature. Retinotoxicity has received the most attention, whereas neuromyotoxicity and cardiotoxicity have been described in isolated case reports. We present 2 cases of potential cardiotoxicity occurring in patients with SLE while receiving long-term HCQ therapy.
To review the incidence, presentation, and mechanism of serious antimalarial toxicity, and to discuss the impact of HCQ on cardiac health in SLE.
The authors reviewed the English-language literature from 1948 to December 2002 using Medline databases.
In addition to our patients, there are 2 published cases of biopsy-proven HCQ cardiotoxicity in the English-language literature. Both occurred in patients with SLE. The literature indicates that antimalarial cardiotoxicity may be of particular importance in patients with SLE given their already increased cardiac risk due to primary heart disease and accelerated atherosclerosis. Endomyocardial biopsy reveals a constellation of findings including vacuolar myopathy, myeloid bodies, and curvilinear bodies.
As HCQ use among SLE patients increases, clinicians should be alert to the possibility of antimalarial cardiotoxicity. The potential severity and reversibility of this complication underscore the importance of timely diagnosis. The cases presented here, one with biopsy and one without, illustrate the utility of endomyocardial biopsy in HCQ-treated SLE patients with cardiac complaints to ensure accurate diagnosis and appropriate management.
羟氯喹（HCQ）广泛用于系统性红斑狼疮（SLE）的长期治疗。尽管临床医生认为其相对安全，但文献中已记录了严重的副作用。视网膜毒性受到的关注最多，而神经肌肉毒性和心脏毒性仅在个别病例报告中有所描述。我们报告2例SLE患者在接受长期HCQ治疗时发生潜在心脏毒性的病例。
回顾严重抗疟药毒性的发生率、表现及机制，并探讨HCQ对SLE患者心脏健康的影响。
作者使用Medline数据库检索了1948年至2002年12月的英文文献。
除我们的患者外，英文文献中有2例经活检证实的HCQ心脏毒性病例。均发生在SLE患者中。文献表明，鉴于SLE患者由于原发性心脏病和加速的动脉粥样硬化导致心脏风险本已增加，抗疟药心脏毒性可能对其尤为重要。心内膜活检显示一系列表现，包括空泡性肌病、髓样小体和曲线状小体。
随着SLE患者中HCQ使用的增加，临床医生应警惕抗疟药心脏毒性的可能性。这种并发症的潜在严重性和可逆性凸显了及时诊断的重要性。此处呈现的病例，一例有活检结果，一例没有，说明了心内膜活检在有心脏症状的HCQ治疗的SLE患者中的作用，以确保准确诊断和适当管理。
