Massalha Ismaell, Zabit Reem, Shalev Aryeh, Bin-Arie Gal
The Legacy Heritage Center & Dr. Larry Norton Institute, Soroka Medical Center, Ben Gurion University, Beer Sheva 84105, Israel.
Department of Oncology, Ziv Medical Center, Safed 13100, Israel.
Diagnostics (Basel). 2025 Aug 18;15(16):2064. doi: 10.3390/diagnostics15162064.
Background and Clinical Significance: Zoledronic acid (ZA) is a widely used bisphosphonate for the prevention of skeletal-related events in patients with metastatic bone disease. While it is generally well tolerated, rare immune-mediated complications may be underrecognized. To date, myocarditis has not been reported in association with ZA. Case Presentation: A 35-year-old woman with metastatic pheochromocytoma developed acute, non-exertional chest pain approximately 36 h after receiving her first intravenous ZA infusion. Laboratory testing revealed elevated high-sensitivity troponin T, peaking at 1182 ng/L. Cardiac magnetic resonance imaging (CMR) demonstrated myocardial edema and subepicardial late gadolinium enhancement, consistent with acute myocarditis per the 2018 revised Lake Louise criteria. An extensive diagnostic workup excluded infectious, autoimmune, and ischemic causes. Symptoms and troponin levels improved following ZA discontinuation and supportive care. In the absence of alternative etiologies, and given the close temporal association with ZA administration, the diagnosis of presumed ZA-associated myocarditis was supported by clinical presentation, biochemical markers, and CMR findings, recognizing that histopathological confirmation is rarely pursued in clinically stable patients. Conclusions: To our knowledge, this is the first reported case of presumed zoledronic acid-associated myocarditis confirmed by cardiac MRI. This report highlights the diagnostic utility of CMR in suspected drug-related cardiac inflammation and the importance of considering myocarditis in patients presenting with unexplained chest pain following ZA infusion, particularly when other causes have been excluded.
唑来膦酸（ZA）是一种广泛用于预防转移性骨病患者骨相关事件的双膦酸盐药物。虽然它通常耐受性良好，但罕见的免疫介导并发症可能未被充分认识。迄今为止，尚未有与ZA相关的心肌炎报道。病例报告：一名35岁患有转移性嗜铬细胞瘤的女性在首次静脉输注ZA后约36小时出现急性、非劳力性胸痛。实验室检查显示高敏肌钙蛋白T升高，峰值达到1182 ng/L。心脏磁共振成像（CMR）显示心肌水肿和心外膜下延迟钆增强，根据2018年修订的路易斯湖标准符合急性心肌炎表现。广泛的诊断性检查排除了感染、自身免疫和缺血性病因。停用ZA并给予支持治疗后，症状和肌钙蛋白水平有所改善。在没有其他病因的情况下，鉴于与ZA给药的密切时间关联，临床表现、生化标志物和CMR结果支持了疑似ZA相关性心肌炎的诊断，同时认识到在临床稳定的患者中很少进行组织病理学确诊。结论：据我们所知，这是首例经心脏MRI确诊的疑似唑来膦酸相关性心肌炎病例。本报告强调了CMR在疑似药物相关心脏炎症诊断中的作用，以及在ZA输注后出现不明原因胸痛的患者中考虑心肌炎的重要性，特别是在排除其他病因时。
