Key result
Chronic hydroxychloroquine exposure is linked to drug-induced cardiomyopathy and coronary microvascular dysfunction.
Case Report (n=1)
This case establishes a novel association between hydroxychloroquine-induced cardiomyopathy and coronary microvascular dysfunction, suggesting an additional mechanism of vascular injury.
May alert clinicians to hydroxychloroquine-related microvascular dysfunction; hypothesis-generating case extends known toxicity and leaves confirmation open.
BACKGROUND: A 69-year-old woman with seropositive rheumatoid arthritis presented with subacute worsening of her chronic chest pain. CASE SUMMARY: Cardiac magnetic resonance demonstrated new diffuse edema, patchy late gadolinium enhancement, and a reduction in myocardial perfusion reserve index, which raised concern for an infiltrative cardiomyopathy leading to microvascular dysfunction. An endomyocardial biopsy resulted in a rare diagnosis of drug-induced cardiomyopathy. DISCUSSION: We report a new association between this drug toxicity and coronary microvascular disease. This represents not only a new finding but potential expanded understanding of the pathophysiology of this disease condition. This finding could have implications for both diagnostic testing and disease management. TAKE-HOME MESSAGES: This case establishes a new relationship between hydroxychloroquine cardiomyopathy and microvascular dysfunction. In addition to the cytotoxic effects of hydroxychloroquine, there may be an additional mechanism of vascular injury leading to the known manifestations with various electrical disturbances, and myocardial dysfunction.
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Richards et al. (2025) conducted a case report in Hydroxychloroquine-induced cardiomyopathy (n=1). Hydroxychloroquine was evaluated. Chronic hydroxychloroquine exposure was associated with drug-induced cardiomyopathy and coronary microvascular dysfunction, demonstrated by reduced myocardial perfusion reserve index and biopsy.
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