eISSN: 2345-2781  
J Renal Inj Prev. 2017;6(1):18-25.
doi: 10.15171/jrip.2017.04
PMID: 28487867
PMCID: PMC5414514
Scopus id: 85040672073

Case Report

Non-ischemic cardiomyopathy after rituximab treatment for membranous nephropathy

Wisit Cheungpasitporn 1, Stephen L. Kopecky 2, Ulrich Specks 3, Kharmen Bharucha 1, Fernando C. Fervenza 1

1 Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
2 Department of Cardiology, Mayo Clinic, Rochester, MN, USA
3 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA

Abstract

Rituximab is an anti-CD20 monoclonal antibody frequently used for the treatment of non-Hodgkin’s lymphoma, chronic lymphocytic leukemia (CLL), rheumatoid arthritis (RA), and anti-neutrophilic cytoplasmic antibody (ANCA)-associated vasculitis. In addition, rituximab has recently been increasingly used as an off-label treatment in a number of inflammatory and systemic autoimmune diseases. It is advised that rituximab infusion may cause infusion reactions and adverse cardiac effects including arrhythmia and angina, especially in patients with prior history of cardiovascular diseases. However, its detailed cardiotoxicity profile and effects on cardiac function were not well described. We report a 51-year-old man who developed non-ischemic cardiomyopathy after rituximab treatment for membranous nephropathy. The patient experienced reduced cardiac functions within 48 hours after the initial infusion, which remained markedly reduced at 9-month follow-up. As the utility of rituximab expands, physicians must be aware of this serious cardiovascular adverse effect.

Implication for health policy/practice/research/medical education:

Rituximab is currently approved by the US Food and Drug Administration (FDA) for the treatment of non-Hodgkin’s lymphoma (NHL), chronic lymphocytic leukemia (CLL), rheumatoid arthritis (RA), antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. In addition, rituximab has recently been used as an off-label treatment in a number of diseases. However, its detailed cardiotoxicity profile and effects on cardiac function are not clearly described in the literature. This case of non-ischemic cardiomyopathy after infusion of rituximab for membranous nephropathy highlights the growing evidence that rituximab can affect cardiac function and requires greater attention as a causative agent of cardiomyopathy.

Please cite this paper as: Cheungpasitporn W, Kopecky SL, Specks US, Bharucha K, Fervenza FC. Non-ischemic cardiomyopathy after rituximab treatment for membranous nephropathy. J Renal Inj Prev. 2017;6(1):18-25. Doi:  10.15171/jrip.2017.04

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