Srichawla Bahadar S
Neurology, University of Massachusetts Chan Medical School, Worcester, USA.
Cureus. 2022 Apr 3;14(4):e23789. doi: 10.7759/cureus.23789. eCollection 2022 Apr.
Dimethyl fumarate (DMF) is an approved oral pharmacologic agent used in the treatment of relapsing-remitting multiple sclerosis (RRMS). Although commonly used in clinical practice, its mechanism of action remains largely unknown. Some frequent side effects associated with this drug are angioedema, hepatic injury, flushing, herpes zoster infection, and abdominal pain among others. A 47-year-old female presented with symptoms of an allergic reaction after initiating DMF therapy. She required intensive care unit admission due to an acute-hypoxic respiratory failure. A transthoracic echocardiogram (TTE) revealed apical ballooning and a left ventricular ejection fraction (LVEF) of 35%-40%. A coronary angiogram revealed no coronary artery disease. The diagnosis of takotsubo cardiomyopathy was made. The patient was managed with high-dose steroids and an epinephrine drip, in addition to a high-flow nasal cannula (HFNC) for respiratory support. At a three-month follow-up, a repeat TTE showed a resolution of the underlying takotsubo cardiomyopathy (CM) with no stunted myocardium and a normal ejection fraction (EF). Here, I highlight a life-threatening case of DMF-induced takotsubo CM and familiarize clinicians and patients with the need for close monitoring of symptoms when initiating disease-modifying drug (DMD) therapy.
富马酸二甲酯（DMF）是一种已获批准的口服药物，用于治疗复发缓解型多发性硬化症（RRMS）。尽管在临床实践中常用，但其作用机制仍 largely 未知。与该药物相关的一些常见副作用包括血管性水肿、肝损伤、潮红、带状疱疹感染和腹痛等。一名47岁女性在开始 DMF 治疗后出现过敏反应症状。由于急性低氧性呼吸衰竭，她需要入住重症监护病房。经胸超声心动图（TTE）显示心尖部气球样变，左心室射血分数（LVEF）为35%-40%。冠状动脉造影显示无冠状动脉疾病。诊断为应激性心肌病。除了使用高流量鼻导管（HFNC）进行呼吸支持外，患者还接受了大剂量类固醇和肾上腺素滴注治疗。在三个月的随访中，重复 TTE 显示潜在的应激性心肌病（CM）得到缓解，心肌无发育不良，射血分数（EF）正常。在此，我强调一例 DMF 诱导的应激性 CM 的危及生命病例，并使临床医生和患者了解在开始疾病修正药物（DMD）治疗时密切监测症状的必要性。
