title: Fatal antimalarial-induced cardiomyopathy: report of 2 cases.
abstract: Chloroquine and hydroxychloroquine are used to chronically treat certain rheumatologic diseases and are generally considered safe. We describe 2 patients with skeletal myopathy and fatal cardiomyopathy-uncommon and underrecognized adverse effects of these agents. Both patients developed arrhythmias and heart failure, and 1 patient had documented diaphragmatic involvement. Muscle specimens showed typical vacuolar myopathy (indicative of impaired autophagy) with myeloid bodies in both patients and curvilinear bodies in 1 patient. Antimalarial-induced cardiomyopathy should be considered in patients receiving these medications with otherwise unexplained muscle weakness or cardiac symptoms. Whether autophagy enhancers can be used to manage such myopathies merits investigation.
authors.affiliation: Division of Rheumatology, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Morteza
authors.initials: M
authors.lastname: Azimian
authors.forename: Sakir H
authors.initials: SH
authors.lastname: Gultekin
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Hata
authors.forename: James B
authors.initials: JB
authors.lastname: Atkinson
authors.forename: Kim A
authors.initials: KA
authors.lastname: Ely
authors.forename: Howard A
authors.initials: HA
authors.lastname: Fuchs
authors.forename: Bret C
authors.initials: BC
authors.lastname: Mobley
mesh_terms: D000328:Adult; D000962:Antimalarials / Q000009:adverse effects* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D009202:Cardiomyopathies / Q000139:chemically induced* / Q000175:diagnosis*; D002738:Chloroquine / Q000009:adverse effects / Q000627:therapeutic use; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D006886:Hydroxychloroquine / Q000009:adverse effects / Q000627:therapeutic use; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy; D008875:Middle Aged
chemical_list: D000962:Antimalarials; D006886:Hydroxychloroquine; D002738:Chloroquine