Verbesselt Matthias, Meekers Evelyne, Vandenberghe Peter, Delforge Michel, Vandenbriele Christophe
Department of Internal Medicine/Cardiology, Katholieke Universiteit Leuven (KUL), University Hospital Leuven (UZ Leuven), Herestraat 49, 3000 Leuven, Belgium.
Department of Hematology, Katholieke Universiteit Leuven (KUL), University Hospital Leuven (UZ Leuven), Herestraat 49, 3000 Leuven, Belgium.
Eur Heart J Case Rep. 2022 Feb 22;6(3):ytac093. doi: 10.1093/ehjcr/ytac093. eCollection 2022 Mar.
Drug-induced myocarditis is a rare complication of certain cancer treatments, characterized by the development of myocardial inflammation shortly after initiation of treatment, potentially leading to heart failure and/or malignant arrhythmias. The development of eosinophilic myocarditis after administration of lenalidomide has been described and bortezomib has been associated with the development of cardiomyopathies and atherosclerosis.
A 69-year-old woman, recently diagnosed with multiple myeloma underwent local radiotherapy for a pathological fracture of the 4th lumbar vertebra and was treated with bortezomib-lenalidomide-dexamethasone. Within 19 days after therapy initiation, she presented with gastrointestinal symptoms, an erythematous pruritic rash, and general fatigue. Surprisingly, routine electrocardiogram (ECG) showed upwardly concave ST-elevation in I and aVL and ST-depressions in II, III, and aVF. Troponin levels were markedly elevated to 5470 ng/L. Complete blood count revealed eosinophilia. Based on further cardiac work-up, including echocardiography, coronary angiography, and cardiac magnetic resonance imaging (MRI) showing positive T2 imaging and patchy subepicardial late gadolinium enhancement, she was diagnosed with hypersensitivity myocarditis. Additional endomyocardial heart biopsy did not reveal any abnormalities, probably due to sampling error. After discontinuation of chemotherapy and prompt treatment with high doses of corticosteroids, the patient recovered.
Diagnosis of drug-induced myocarditis can be challenging and even long known widely used (chemo)therapy should be considered a potential trigger. Early diagnosis and treatment are crucial, warranting alertness for suggestive symptoms. Cardiac biomarkers, ECG monitoring, and cardiac MRI are key to confirm the diagnosis. In patients with preserved left ventricular systolic function, two-dimensional speckle tracking echocardiography can provide additional diagnostic information. Every patient presenting with eosinophilia and/or acute onset of auto-immune symptoms after initiation of therapy with lenalidomide/bortezomib deserves prompt cardiac screening. The gold standard remains an endomyocardial biopsy, although sampling error may occur.
药物性心肌炎是某些癌症治疗中罕见的并发症，其特征为治疗开始后不久出现心肌炎症，可能导致心力衰竭和/或恶性心律失常。来那度胺给药后嗜酸性粒细胞性心肌炎的发生已有报道，硼替佐米与心肌病和动脉粥样硬化的发生有关。
一名69岁女性，近期诊断为多发性骨髓瘤，因第4腰椎病理性骨折接受局部放疗，并接受硼替佐米-来那度胺-地塞米松治疗。治疗开始后19天内，她出现胃肠道症状、红斑瘙痒性皮疹和全身乏力。令人惊讶的是，常规心电图（ECG）显示I导联和aVL导联ST段呈向上凹形抬高，II、III和aVF导联ST段压低。肌钙蛋白水平显著升高至5470 ng/L。全血细胞计数显示嗜酸性粒细胞增多。基于进一步的心脏检查，包括超声心动图、冠状动脉造影和心脏磁共振成像（MRI）显示T2成像阳性和心外膜下片状延迟钆增强，她被诊断为过敏性心肌炎。额外的心内膜心肌活检未发现任何异常，可能是由于取样误差。停用化疗并及时给予高剂量糖皮质激素治疗后，患者康复。
药物性心肌炎的诊断可能具有挑战性，即使是长期广泛使用的（化疗）治疗也应被视为潜在诱因。早期诊断和治疗至关重要，需要对提示性症状保持警惕。心脏生物标志物、心电图监测和心脏MRI是确诊的关键。对于左心室收缩功能保留的患者，二维斑点追踪超声心动图可提供额外的诊断信息。每一位在接受来那度胺/硼替佐米治疗后出现嗜酸性粒细胞增多和/或自身免疫症状急性发作的患者都应接受及时的心脏筛查。金标准仍然是心内膜心肌活检，尽管可能会出现取样误差。
