Hydroxychloroquine (HQ) is commonly prescribed for autoimmune diseases such as systemic lupus erythematosus. We report a case of a 75-year-old female presenting with de novo decompensated heart failure and restrictive cardiomyopathy (left ventricular ejection fraction: 40%-45%) after treatment with HQ for more than 11 years. Hydroxychloroquine was discontinued, and follow-up echocardiogram 57 days after discontinuation showed normalization of her left ventricular ejection fraction. A score of 7 on the Naranjo Adverse Drug Reaction Probability Scale indicates that HQ is a probable cause of this patient’s cardiomyopathy. An adverse drug effect due to HQ should be considered in treated patients who present with restrictive cardiomyopathy. Discontinuation may allow for partial or complete reversal of the cardiomyopathy.
Pons-EstelGJAlarconGSScofieldL. Understanding the epidemiology and progression of systemic lupus erythematosus. Semin Arthritis Rheu. 2010;39(4):257–68.
2.
RomanMJSalmonJE. Cardiovascular manifestations of rheumatologic diseases. Circulation. 2007;116(20):2346–2355.
3.
TonnesmannEKandolfRLewalterT. Chloroquine cardiomyopathy—a review of the literature. Immunopharm Immunot. 2013;35(3):434–442.
4.
EstesMLEwing-WilsonDChouSM. Chloroquine neuromyotoxicity. Clinical and pathologic perspective. Am J Med. 1987;82(3):447–455.
5.
RatliffNBEstesMLMylesJL. Diagnosis of chloroquine cardiomyopathy by endomyocardial biopsy. New Engl J Med. 1987;316(4):191–193.
6.
NordJEShahPKRinaldiRZ. Hydroxychloroquine cardiotoxicity in systemic lupus erythematosus: a report of 2 cases and review of the literature. Sem Arthritis Rheu. 2004;33(5):336–351.
7.
KeatingRJBhatiaSAminS. Hydroxychloroquine-induced cardiotoxicity in a 39-year-old woman with systemic lupus erythematosus and systolic dysfunction. J Am Soc Echocardiog. 2005;18(9):981.
SoongTRBarouchLAChampionHC. New clinical and ultrastructural findings in hydroxychloroquine-induced cardiomyopathy—a report of 2 cases. Hum Pathol. 2007;38(12):1858–1863.
10.
ManoharVAModerKGEdwardsWD. Restrictive cardiomyopathy secondary to hydroxychloroquine therapy. J Rheumatol. 2009;36(2):440–441.
11.
LeeJHChungWBKangJH. A case of chloroquine-induced cardiomyopathy that presented as sick sinus syndrome. Korean Circ J. 2010;40(11):604–608.
12.
HartmannMMeekILvan HouwelingenGK. Acute left ventricular failure in a patient with hydroxychloroquine-induced cardiomyopathy. Neth Heart J. 2011;19(11):482–485.
13.
MuthukrishnanPRoukozHGraftonG. Hydroxychloroquine-induced cardiomyopathy: a case report. Circ Heart Fail. 2011;4(2):e7–e8.
14.
Newton-ChehCLinAEBaggishAL. Case records of the Massachusetts General Hospital. Case 11-2011. A 47-year-old man with systemic lupus erythematosus and heart failure. N Engl J Med. 2011;364(15):1450–1460.
15.
AbbasiSTarterLFarzaneh-FarR. Hydroxychloroquine: a treatable cause of cardiomyopathy. J Am Coll Cardiol. 2012;60(8):786.
FrustaciAMorganteEAntuzziD. Inhibition of cardiomyocyte lysosomal activity in hydroxychloroquine cardiomyopathy. Int J Cardiol. 2012;157(1):117–119.
18.
JoyceEFabreAMahonN. Hydroxychloroquine cardiotoxicity presenting as a rapidly evolving biventricular cardiomyopathy: key diagnostic features and literature review. Eur Heart J Acute Cardiovasc Care. 2013;2(1):77–83.
19.
YogasundaramHPutkoBNTienJ. Hydroxychloroquine-induced cardiomyopathy: case report, pathophysiology, diagnosis, and treatment. Can J Cardiol. 2014;30(12):1706–1715.
20.
Avina-ZubietaJAGalindo-RodriguezGNewmanS. Long-term effectiveness of antimalarial drugs in rheumatic diseases. Ann Rheum Dis. 1998;57(10):582–587.
21.
BertsiasGIoannidisJPBoletisJ; Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics. EULAR recommendations for the management of systemic lupus erythematosus. Report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics. Ann Rheum Dis. 2008;67(2):195–205.
22.
MackenzieAH. Pharmacologic actions of 4-aminoquinoline compounds. Am J Med. 1983;75(1a):5–10.
23.
MehtaARicciRWidmerU. Fabry disease defined: baseline clinical manifestations of 366 patients in the Fabry Outcome Survey. Eur J Clin Invest. 2004;34(3):236–242.
24.
NaranjoCABustoUSellersEM. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981;30(2):239–245.
25.
McChesneyEWShekoskyJMHernandezPH. Metabolism of chloroquine-3-14C in the rhesus monkey. Biochem Pharmacol. 1967;16(2):2444–2447.
26.
HomewoodCAWarhurstDCPetersW. Lysosomes, pH and the anti-malarial action of chloroquine. Nature. 1972;235(5332):50–52.
27.
OhkumaSPooleB. Fluorescence probe measurement of the intralysosomal pH in living cells and the perturbation of pH by various agents. Proc Natl Acad Sci U S A. 1978;75(7):3327–3331.
28.
StauberWTHedgeAMTroutJJ. Inhibition of lysosomal function in red and white skeletal muscles by chloroquine. Exp Neurol. 1981;71(2):295–306.
