Hydroxychloroquine Cardiotoxicity Mimicking Transthyretin Cardiac Amyloidosis in a Patient With HFpEF

Q4 Medicine

JACC. Case reports Pub Date : 2026-10-21 DOI:10.1016/j.jaccas.2026.110638

Moses Asempah MD, Elie Kozaily MD, Izabela Abissi DO, Clarence Silvis DO, Corynne Caballero MD, Deven Champaneri MD, Sheldon E. Litwin MD, Matthew J. Belanger MD

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Abstract

Background

Hydroxychloroquine (HCQ) is an immunomodulatory drug used in systemic lupus erythematosus and other rheumatologic disorders, with rare but potentially severe cardiotoxic effects.

Case Summary

A 77-year-old woman with a history of systemic lupus erythematosus and heart failure with preserved ejection fraction presented with subacute worsening chest pain, dyspnea, palpitations, and neuropathy. Electrocardiogram showed low voltage; echocardiogram revealed moderate concentric left ventricular hypertrophy with reduced global longitudinal strain without apical sparing. Coronary angiography was normal. Technetium-99m pyrophosphate scintigraphy showed focal grade 2 uptake. Endomyocardial biopsy revealed widespread myocyte hypertrophy and lysosomal curvilinear bodies consistent with HCQ cardiotoxicity.

Discussion

HCQ is a long-term medication used in connective tissue diseases. Patients with rheumatologic conditions are at increased risk for heart failure with preserved ejection fraction independent of HCQ use. Recognition of insidious organ toxicity can be challenging. HCQ toxicity can cause infiltrative pathology and mimic transthyretin cardiac amyloidosis. Endomyocardial biopsy is key for definitive diagnosis.

Take-Home Message

In patients with an equivocally positive technetium-99m pyrophosphate scan and chronic HCQ use, endomyocardial biopsy should be considered to differentiate drug toxicity from transthyretin cardiac amyloidosis.

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羟基氯喹心脏毒性模拟HFpEF患者转甲状腺素型心脏淀粉样变性

羟氯喹（hydroxychloroquine， HCQ）是一种用于系统性红斑狼疮和其他风湿病的免疫调节药物，具有罕见但潜在严重的心脏毒性作用。病例总结：77岁女性，有系统性红斑狼疮和心力衰竭病史，射血分数保留，表现为亚急性加重的胸痛、呼吸困难、心悸和神经病变。心电图示低电压；超声心动图显示中度同心性左心室肥厚，整体纵向应变减少，无心尖保留。冠状动脉造影正常。锝-99m焦磷酸盐闪烁成像显示病灶2级摄取。心肌内膜活检显示广泛的心肌细胞肥大和溶酶体曲线体，与HCQ心脏毒性一致。hcq是一种用于结缔组织疾病的长期药物。风湿病患者保留射血分数后发生心力衰竭的风险增加，与使用HCQ无关。识别潜在的器官毒性可能具有挑战性。HCQ毒性可引起浸润性病理和模拟甲状腺素转甲状腺素型心脏淀粉样变性。心内膜肌活检是确诊的关键。对于99m焦磷酸盐扫描和慢性HCQ使用模棱两可阳性的患者，应考虑心内膜活检，以区分药物毒性和经甲状腺素心脏淀粉样变性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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