title: Azacitidine-Induced Pericarditis: A Case Series.
abstract: OBJECTIVE
  To describe three cases of pericarditis probably related to azacitidine administration in a span of 3 years at our center.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Comprehensive cancer center within a large, academic medical center.
  
  
  METHODS
  Three patients with high-grade myelodysplastic syndrome or acute myeloid leukemia who received azacitidine.
  
  
  METHODS
  None.
  
  
  METHODS
  None.
  
  
  RESULTS
  Patient 1 presented with pericarditis after cycle 2 of azacitidine, patient 3 presented 3 weeks after completing cycle 5, and patient 2 presented during cycle 1. All patients were treated symptomatically and responded to corticosteroids. None of the patients were re-challenged with hypomethylating agents. Use of the Naranjo adverse drug reaction probability scale indicated a probable adverse drug reaction (score of 6) for patients 1 and 3 and a possible adverse drug reaction (score of 3) for patient 2.
  
  
  CONCLUSIONS
  With the exclusion of other common causes of pericarditis, we believe it is likely that azacitidine was responsible for the findings in our patients. Providers caring for patients receiving hypomethylating agents should consider this potential adverse drug reaction in the setting of unexplained chest pain or other clinical signs consistent with cardiotoxicity.
authors.affiliation: Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Matthew
authors.identifier: http://orcid.org/0000-0002-1402-5554
authors.initials: M
authors.lastname: Newman
authors.affiliation: Department of Internal Medicine, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
authors.forename: Midhun
authors.initials: M
authors.lastname: Malla
authors.affiliation: Division of Hematologic Malignancies, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland.
authors.forename: Ivana
authors.initials: I
authors.lastname: Gojo
mesh_terms: D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects* / Q000627:therapeutic use; D001374:Azacitidine / Q000009:adverse effects* / Q000627:therapeutic use; D002637:Chest Pain / Q000209:etiology / Q000517:prevention & control; D003131:Combined Modality Therapy; D015254:DNA Modification Methylases / Q000037:antagonists & inhibitors*; D003937:Diagnosis, Differential; D016903:Drug Monitoring; D004791:Enzyme Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000188:drug therapy; D010493:Pericarditis / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D011241:Prednisone / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000964:Antimetabolites, Antineoplastic; D004791:Enzyme Inhibitors; D005938:Glucocorticoids; D015254:DNA Modification Methylases; D001374:Azacitidine; D011241:Prednisone; D008775:Methylprednisolone
keywords: azacitidine; demethylating agent; leukemia; myelodysplastic syndromes; pericarditis