Abrupt baclofen withdrawal induced severe, reversible non-ischemic cardiomyopathy with an ejection fraction of 20-30%, which fully recovered within 10 days of resuming the medication.
Case Report (n=1)
Baclofen withdrawal can cause a profound, reversible, non-ischemic cardiomyopathy that mimics septic cardiomyopathy, highlighting the critical importance of continuing baclofen in chronic users during hospitalization.
Abstract Introduction While severe autonomic instability is a well-known consequence of abrupt baclofen withdrawal, its potential to induce acute, potentially reversible cardiomyopathy is not widely recognized. We present a case where this rare complication presented as de novo cardiogenic shock on hospital day 2, confounded by a severe infection diagnosed on presentation. Case Presentation A 40-year-old man with C-spine paraplegia, reliant on high-dose oral baclofen (40mg TID) for spasticity, was admitted to the ICU for septic shock from ESBL E. coli urinary tract infection. His cardiac function was known to be normal, with an ejection fraction (EF) of 55% two months prior. During his admission, his home baclofen was held in an attempt to clear his septic delirium. While his infection showed signs of improvement, he suffered a catastrophic decompensation approximately 36 hours after his last baclofen dose. He developed severe agitation, hyperthermia (104-106 °F), and profound hypotension, requiring ICU re-admission. His condition rapidly progressed to obtundation, necessitating mechanical ventilation. An urgent echocardiogram revealed new, severe global systolic dysfunction with an EF of 20-30%, elevated pulmonary pressures (RVSP 40 mmHg), and rising troponins. Clinical recognition of baclofen withdrawal resulted in emergent resumption of baclofen. The patient’s response was immediate and dramatic. Within 24 hours of restarting baclofen, his fever resolved, vasopressors were weaned, and he was successfully extubated. A follow-up left heart catheterization on hospital day 10 confirmed a fully recovered left ventricle and no obstructive coronary artery disease. Conclusion Baclofen withdrawal is capable of inducing a profound, reversible, non-ischemic cardiomyopathy that can easily be mistaken for a septic cardiomyopathy. Our case demonstrates that this complication is not just a neurologic event but a severe cardiovascular one. It underscores the critical importance of continuing baclofen in chronic users during hospitalization and serves as a reminder to include withdrawal in the differential diagnosis of any at-risk patient who presents with acute, unexplained heart failure. This abstract is funded by: None
Khan et al. (Fri,) conducted a case report in Baclofen withdrawal-induced cardiomyopathy (n=1). Baclofen withdrawal and subsequent resumption was evaluated. Abrupt baclofen withdrawal induced severe, reversible non-ischemic cardiomyopathy with an ejection fraction of 20-30%, which fully recovered within 10 days of resuming the medication.