Pericarditis after high-dose chemotherapy: more frequent than expected?
BACKGROUND
Pericarditis is a rare side-effect of chemotherapy and has been reported following administration of cyclophosphamide, doxorubicin and other drugs but not treosulfan.


METHODS
We report on 2 patients with retrosternal chest pain and typical widespread upward concave ST-segment elevation in the 12-lead electrocardiogram prompting the diagnosis of acute pericarditis. The patients had received treatment for multiple myeloma or relapsed mantle cell lymphoma with high-dose treosulfan alone or in combination with etoposide and carboplatin followed by autologous stem cell transplantation 5 days before onset of the symptoms. In both patients, no serological evidence of viral infection was found. Serum creatine kinase and serum cardiac troponin I remained unchanged. Within 24 h of onset of the symptoms, C-reactive protein increased from normal values (< 5 mg/l) to 95 mg/l and 115 mg/l, respectively. In one of the patients, a paroxysmal supraventricular arrhythmia occurred that persisted for 2 days. After treatment with diclofenac, both patients recovered completely within 1 week.


CONCLUSIONS
The differential diagnosis of chest pain in the setting of high-dose chemotherapy with e.g. treosulfan should include pericarditis. The pathogenesis remains unclear. Alongside infections, direct toxic or immunological drug-related mechanisms are suggested.
Bock
Jurgen
J
Department of Internal Medicine I, University of Regensburg, Germany.
Doenitz
Anna
A
Andreesen
Reinhard
R
Reichle
Albrecht
A
Hennemann
Burkhard
B
D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects*; D004358:Drug Therapy / Q000706:statistics & numerical data*; D064420:Drug-Related Side Effects and Adverse Reactions; D006801:Humans; D008297:Male; D008875:Middle Aged; D010493:Pericarditis / Q000139:chemically induced* / Q000453:epidemiology*; D015995:Prevalence; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D016896:Treatment Outcome
D000970:Antineoplastic Agents