Rituximab-induced Takotsubo syndrome: more cardiotoxic than it appears?
Rituximab is used for treatment of multiple haematological cancers. Caution for use is advised in patients with significant cardiorespiratory disease due to known cases of exacerbations of angina and arrhythmias. However, its cardiotoxicity profile is not as well recognised as other monoclonal antibodies such as transtuzumab. We report a case of a 66-year-old man who developed Takotsubo's cardiomyopathy (TC) after an elective infusion of rituximab. This case is exceptional in that rituximab has not been linked to TC, and the vast majority of chemotherapy-linked and immunotherapy-linked TC reactions have occurred during initial infusions. We also discuss the different mechanisms which link TC to immunotherapy and chemotherapy, and propose that there may be a potential for risk-stratifying recipients of this frequently used immunotherapy prior to administering treatment.
Department of Medicine, Royal Free London NHS Foundation Trust, London, UK.
Kien Hoe
KH
Ng
Royal Marsden Hospital, London, UK.
Claire
C
Dearden
Royal Marsden Hospital, London, UK.
Pascale
P
Gruber
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects*; D017298:Bisoprolol / Q000627:therapeutic use; D004562:Electrocardiography; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy; D008297:Male; D017257:Ramipril / Q000627:therapeutic use; D000069283:Rituximab / Q000009:adverse effects*; D054549:Takotsubo Cardiomyopathy / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D016896:Treatment Outcome
D000959:Antihypertensive Agents; D000970:Antineoplastic Agents; D000069283:Rituximab; D017257:Ramipril; D017298:Bisoprolol