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Fatal Antimalarial-Induced Cardiomyopathy: Report of 2 Cases

Azimian, Morteza MD*; Gultekin, Sakir H. MD; Hata, Jessica L. MD; Atkinson, James B. MD; Ely, Kim A. MD; Fuchs, Howard A. MD*; Mobley, Bret C. MD

JCR: Journal of Clinical Rheumatology: October 2012 - Volume 18 - Issue 7 - p 363–366
doi: 10.1097/RHU.0b013e31826852db
Case Reports

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.

From the *Division of Rheumatology, Vanderbilt University Medical Center, Nashville, TN; †Department of Pathology, Oregon Health and Science University, Portland, OR; and ‡Department of Pathology, Vanderbilt University Medical Center, Nashville, TN.

Drs. Azimian and Gultekin contributed equally to this article. Drs. Fuchs and Mobley contributed equally to this article.

Abstract was submitted as a poster to the Sixth Annual National Young Rheumatology Investigator Forum (2012). A poster of one of the cases was also presented at the 87th Annual Meeting of the American Association of Neuropathologists in 2011.

The authors did not receive funding for this work.

The authors declare no conflict of interest.

Correspondence: Howard A. Fuchs, MD, Division of Rheumatology, Vanderbilt University Medical Center, 1161 21st Ave S, MCN S-1115, Nashville, TN 37232-2681. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.