title: Delayed Myocardial Infarction Associated With Rituximab Infusion: A Case Report and Literature Review.
abstract: To report a case of delayed myocardial infraction after rituximab infusion. A 52-year-old woman with history of refractory idiopathic thrombocytopenic purpura had hypertension, seizure, and mild coronary artery disease and received rituximab; after 24 hours, she returned back with chest pain, nausea, and vomiting. Her electrocardiogram showed a ST-elevation in the II, III, aVF, and aVR lead and ST depression in I and aVL lead; after another complementary test, the myocardial infraction was confirmed. The patient was sent to the intensive care unit, and after 8-day hospitalization, she was discharged. Based on the Naranjo Probability Scale, the likelihood of rituximab-induced acute myocardial infarction in this case was probable. Rituximab is generally well tolerated; however, cardiovascular effects of this drug can be fatal. The side effects usually occur during or a short time after infusion; this case demonstrated that rituximab side effects may occur with delay. This case demonstrates, although a rare phenomenon, myocardial infraction may occur after 24 hours and clinicians should be aware of this fatal effect even after a period of time in patients receiving rituximab, especially in patients with history of coronary artery disease.
authors.affiliation: 1Clinical Pharmacy Department, Hamedan University of Medical Sciences, Hamadan, Iran; 2Applied Physiology Research Center, Isfahan Cardiovascular Research Institute, Department of Pharmacology, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran; 3Department of Clinical Pharmacy, Faculty of Pharmacy-International Campus, Iran University of Medical Sciences, Tehran, Iran; and 4Faculty of Pharmacy, Lorestan University of Medical Sciences, Khorramabad, Iran.
authors.forename: Maryam
authors.initials: M
authors.lastname: Mehrpooya
authors.forename: Golnaz
authors.initials: G
authors.lastname: Vaseghi
authors.forename: Azadeh
authors.initials: A
authors.lastname: Eshraghi
authors.forename: Neda
authors.initials: N
authors.lastname: Eslami
mesh_terms: D005260:Female; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000139:chemically induced*; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000188:drug therapy; D000069283:Rituximab / Q000009:adverse effects*
chemical_list: D000069283:Rituximab