Key result
Hydroxychloroquine therapy in a patient with systemic lupus erythematosus and end-stage renal disease led to severe QTc prolongation and syncope, which improved after drug discontinuation.
Why the study?
Does discontinuation of hydroxychloroquine and treatment with mexiletine improve severe QTc prolongation in a patient with systemic lupus erythematosus and end stage renal disease?
Case Report (n=1)
Does discontinuation of hydroxychloroquine and treatment with mexiletine improve severe QTc prolongation in a patient with systemic lupus erythematosus and end stage renal disease?
Hydroxychloroquine can cause life-threatening severe QTc prolongation, particularly in patients with underlying renal failure and pre-existing mild QT prolongation, which can be managed by drug discontinuation and mexiletine.
QTc monitoring may warrant consideration with hydroxychloroquine in ESRD; this case leaves open causality and population risk.
We present a case of a syncopal episode resulting from significant QT interval prolongation in a patient on hydroxychloroquine for the treatment of systemic lupus erythematosus and end stage renal disease. The patient had been treated with hydroxychloroquine for two years prior to presentation. After thorough workup for secondary causes of QT interval prolongation hydroxychloroquine was discontinued and the patient's QT interval shortened. The patient was treated with mexiletine to prevent sudden ventricular arrhythmias, which was unique compared to other documented cases in which lidocaine was used. The patient was noted to have mild prolongation of the QT interval on electrocardiogram prior to initiation of hydroxychloroquine therapy which was exacerbated by its use and may have been caused due to toxicity from underlying renal failure.
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O’Laughlin et al. (2016) conducted a case report in Systemic lupus erythematosus and end stage renal disease (n=1). Hydroxychloroquine was evaluated on QT interval prolongation and syncope. Hydroxychloroquine therapy in a patient with systemic lupus erythematosus and end-stage renal disease led to severe QTc prolongation and syncope, which improved after drug discontinuation.
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