title: Severe heart failure after bortezomib treatment in a patient with multiple myeloma: a case report and review of the literature.
abstract: BACKGROUND
  Bortezomib is a novel, first-in-class peptide which reversibly inhibits the proteasome and is Food and Drug Administration approved for the treatment of multiple myeloma, non-Hodgkin lymphoma, Waldenström's macroglobulinemia, and systemic light chain amyloidosis, among others.
  
  
  METHODS
  Very few cases of bortezomib-induced cardiotoxicity have been reported in the literature, and most of them have been confounded by the previous use of anthracyclins. We reviewed the case of a 56-year-old woman with a medical history of well-controlled hypertension who was newly diagnosed with International Staging System stage I multiple myeloma. She presented with new symptoms of exertional dyspnea, paroxysmal nocturnal dyspnea, and orthopnea after a 4th cycle of a bortezomib/dexamethasone-based chemotherapy. Clinical examination was consistent with heart failure. 2-D echocardiogram showed an left ventricular ejection fraction of 25%, abnormal wall motion, severe eccentric mitral regurgitation, and moderate pericardial effusion. Coronary angiogram showed normal coronaries, and cardiac magnetic resonance did not show delayed gadolinium enhancement.
  
  
  CONCLUSIONS
  We reviewed the possible mechanisms involved in cardiotoxicity caused by bortezomib, and the diagnostic methods and importance of early identification of this adverse event. Differential diagnoses such as cardiac amyloidosis and viral myocarditis are also discussed. To our knowledge, this is the first case where pericardial effusion and mitral regurgitation were described after bortezomib treatment.
authors.affiliation: Department of Internal Medicine, University of Connecticut Health Center, West Hartford, Conn. 06107, USA. Mbockorny@resident.uchc.edu
authors.forename: Margarita
authors.initials: M
authors.lastname: Bockorny
authors.forename: Saneka
authors.initials: S
authors.lastname: Chakravarty
authors.forename: Peter
authors.initials: P
authors.lastname: Schulman
authors.forename: Bruno
authors.initials: B
authors.lastname: Bockorny
authors.forename: Robert
authors.initials: R
authors.lastname: Bona
mesh_terms: D000686:Amyloidosis / Q000139:chemically induced / Q000175:diagnosis; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001897:Boronic Acids / Q000009:adverse effects*; D000069286:Bortezomib; D005260:Female; D006333:Heart Failure / Q000139:chemically induced*; D006801:Humans; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy*; D009205:Myocarditis / Q000175:diagnosis; D061988:Proteasome Inhibitors / Q000009:adverse effects*; D011719:Pyrazines / Q000009:adverse effects*
chemical_list: D000970:Antineoplastic Agents; D001897:Boronic Acids; D061988:Proteasome Inhibitors; D011719:Pyrazines; D000069286:Bortezomib