Key result
Multimodal cardiac imaging enables early detection of suspected cyclophosphamide-induced hemorrhagic myocarditis.
Why the study?
Cyclophosphamide-induced hemorrhagic myocarditis is a rare cardiotoxicity with limited reported cases, especially at doses below 100 mg/kg.
Case Report (n=1)
This case highlights the rare occurrence of nonfatal cyclophosphamide-induced hemorrhagic myocarditis at a dose <100 mg/kg, emphasizing the need for expedited multimodal cardiac imaging when this cardiotoxicity is suspected.
Alerts clinicians to consider multimodal imaging in suspected cases; leaves open prospective validation.
BACKGROUND: Cyclophosphamide is a widely used chemotherapeutic agent with a spectrum of toxicities, including a rare drug-related hemorrhagic myocarditis. CASE SUMMARY: A 63 -year-old male with myelofibrosis underwent haploidentical stem cell transplantation with 95 mg/kg cyclophosphamide conditioning. He developed tachycardia, lower-extremity edema, and pulmonary congestion 8 days later. Troponin-T was 512 ng/L, and N-terminal pro-brain natriuretic peptide was 20,142 pg/mL, each previously normal. Electrocardiogram showed low-voltage QRS complexes in limb leads. Echocardiography demonstrated significant left ventricular wall thickening (17 mm), preserved left ventricular ejection fraction (54%), and decreased global longitudinal strain (-9%), all previously normal. Cardiac magnetic resonance imaging suggested myocardial edema and inflammation. Left ventricular T2∗ value near 20 ms suggested intramyocardial hemorrhage. Volume overload and supraventricular arrhythmias were managed conservatively. DISCUSSION: To our knowledge, there are no reported cases of nonfatal cyclophosphamide-induced hemorrhagic myocarditis at a dose <100 mg/kg. TAKE-HOME MESSAGE: An expedited multimodal cardiac imaging approach is warranted when this rare cardiotoxicity is suspected.
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Rivera et al. (2026) conducted a case report in Cyclophosphamide-induced hemorrhagic myocarditis (n=1). Cyclophosphamide was evaluated on Development of hemorrhagic myocarditis. A 63-year-old male developed nonfatal hemorrhagic myocarditis 8 days after receiving 95 mg/kg cyclophosphamide conditioning, highlighting the need for expedited multimodal cardiac imaging.
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