IMAGES IN CARDIOLOGY Chloroquine-Induced Transition From Dilated to Restrictive Cardiomyopathy Maurizio Pieroni, MD, PHD,* Costantino Smaldone, MD,* Antonia Camporeale, MD,* Carolina Ierardi, MD,* Giacomo Dell’Antonio, MD,† Fulvio Bellocci, MD,* Filippo Crea, MD* Rome and Milan, Italy From the *Cardiology Department, Catholic University, Rome, Italy; and the †Pathology Department, San Raffaele Hospital, Milan, Italy. Manuscript received February 25, 2010; accepted March 2, 2010. I n August 2004, a 59-year-old woman received the diagnosis of idiopathic dilated cardiomyopathy on the basis of normal coronary angiography and magnetic resonance evidence of a hypo- kinetic, dilated, nonhypertrophic left ventricle (A). A biventricular implantable cardioverter- defibrillator was inserted with significant improvement of cardiac function and symptoms. A mixed connective tissue disease was also diagnosed, and a treatment with chloroquine (600 mg/day) was started. The patient was lost at follow-up but was readmitted in August 2009 for worsening heart failure. Two-dimensional echocardiogram showed severe concentric hypertrophy of left and right ventricle (interventricular septum 16.5 mm), reduced ejection fraction (40%), bi-atrial enlargement, and a restrictive filling pattern (B, Online Videos 1 and 2). Left ventricular endomyocardial biop- sies showed hypertrophy and diffuse vacuolization of myocytes (C), suggesting glycolipids accumu- lation. Congo-red staining was negative for amyloid deposition. Transmission electron microscopy (D) revealed the presence of lamellar myelinoid (arrows) and curvilinear bodies (asterisks) within the myocytes confirming the diagnosis of chloroquine-induced cardiomyopathy (1). REFERENCE 1. Roos JM, Aubry MC, Edwards WD. Chloroquine cardiotoxicity: clinico-pathologic features in three patients and comparison with three patients with Fabry disease. Cardiovasc Pathol 2002;11:277– 83. Journal of the American College of Cardiology Vol. 57, No. 4, 2011 © 2011 by the American College of Cardiology Foundation ISSN 0735-1097/$36.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2010.03.109

Chloroquine-Induced Transition From Dilated to Restrictive Cardiomyopathy

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Page 1: Chloroquine-Induced Transition From Dilated to Restrictive Cardiomyopathy

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IMAGES IN CARDIOLOGY

Chloroquine-Induced TransitionFrom Dilated to Restrictive CardiomyopathyMaurizio Pieroni, MD, PHD,* Costantino Smaldone, MD,* Antonia Camporeale, MD,*Carolina Ierardi, MD,* Giacomo Dell’Antonio, MD,† Fulvio Bellocci, MD,* Filippo Crea, MD*

Rome and Milan, Italy

rom the *Cardiologyepartment, Catholicniversity, Rome, Italy; and

he †Pathology Department,an Raffaele Hospital,ilan, Italy.anuscript received

ebruary 25, 2010;ccepted March 2, 2010.

I n August 2004, a 59-year-old woman received the diagnosis of idiopathic dilated cardiomyop-athy on the basis of normal coronary angiography and magnetic resonance evidence of a hypo-kinetic, dilated, nonhypertrophic left ventricle (A). A biventricular implantable cardioverter-

defibrillator was inserted with significant improvement of cardiac function and symptoms. A mixedconnective tissue disease was also diagnosed, and a treatment with chloroquine (600 mg/day) wasstarted. The patient was lost at follow-up but was readmitted in August 2009 for worsening heartfailure. Two-dimensional echocardiogram showed severe concentric hypertrophy of left and rightventricle (interventricular septum 16.5 mm), reduced ejection fraction (40%), bi-atrial enlargement,and a restrictive filling pattern (B, Online Videos 1 and 2). Left ventricular endomyocardial biop-sies showed hypertrophy and diffuse vacuolization of myocytes (C), suggesting glycolipids accumu-lation. Congo-red staining was negative for amyloid deposition. Transmission electron microscopy(D) revealed the presence of lamellar myelinoid (arrows) and curvilinear bodies (asterisks) withinthe myocytes confirming the diagnosis of chloroquine-induced cardiomyopathy (1).

ublished by Elsevier Inc. doi:10.1016/j.jacc.2010.03.109

EFERENCE

1. Roos JM, Aubry MC, Edwards WD. Chloroquine

cardiotoxicity: clinico-pathologic features in three pa-

tients and comparison with three patients with Fabry

disease. Cardiovasc Pathol 2002;11:277–83.

http://jaccjacc.cardiosource.com/vol57/issue4/0823_VID1-vol57iss4.avi

http://jaccjacc.cardiosource.com/vol57/issue4/0823_VID2-vol57iss4.avi