Title : Non-ischemic cardiomyopathy after rituximab treatment for mucous membrane pemphigoid
Abstract:
Introduction: Mucous membrane pemphigoid (MMP) is a rare, chronic, autoimmune disease presenting with subepithelial blistering and erosive lesions on the mucosal surface of the mouth, eyes, and occasionally the pharynx. While initial treatment of mild pemphigoid of the oral cavity can be treated with topical steroid therapy, refractory treatment could require biologic therapy. Rituximab is a chimeric monoclonal antibody directed against CD20 on pre-B and B lymphocytes that has shown success in treating refractory MMP. We aim to describe a unique clinical case of a patient with mucous membrane pemphigoid who developed non-ischemic cardiomyopathy after rituximab treatment.
Case presentation: 62-year-old female who originally presented to the hospital due to dyspnea and chest pain, subsequently developed non-ischemic cardiomyopathy. Cardiac workup was obtained in the form of echocardiogram and nuclear medicine stress test. Workup was concerning for a non-ischemic cardiomyopathy secondary to rituximab treatment.
Conclusion: Patients undergoing treatment for any chronic condition should have a thorough cardiac workup, with caution used in patients with underlying cardiac disease. Pretreatment and posttreatment 2D echocardiogram should be considered in all patients. Multiple reports of cardiotoxicity have been reported in patients receiving rituximab, including arrythmias, cardiogenic shock, and myocardial infarction. Our case highlights the development of non-ischemic cardiomyopathy after rituximab treatment for MMP and subsequent initiation of guideline directed medical therapy.
