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Diagnosis and Management of Cancer Therapy-Related Myocarditis in a Young Female: A Case Report and Review of Literature Publisher Pubmed



Emami AH1 ; Alizadehasl A2 ; Sayad M2 ; Shavandi F3 ; Firoozbakhsh P4 ; Meshgi S5 ; Roudini K6 ; Dokhani N2
Authors
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Authors Affiliations
  1. 1. Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
  2. 2. Cardio-Oncology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
  3. 3. Student Research Committee, Hamadan University of Medical Sciences, School of Medicine, Hamadan, Iran
  4. 4. Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
  5. 5. Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
  6. 6. Department of internal medicine, Hematology and Medical oncology ward, Cancer research center, Imam Khomeini hospital complex, Tehran University of medical sciences, cancer institute, Tehran, Iran

Source: BMC Cardiovascular Disorders Published:2024


Abstract

Background: The treatment of choice for Extra-osseous Ewing’s sarcoma/primitive neuroectodermal tumor (ES/PNET), a rare neoplasm, is the VAC/IE regimen. This regimen includes Doxorubicin, Vincristine, Cyclophosphamide, Ifosfamide, and Etoposide, all of which have cardiotoxic effects. Myocarditis, a potentially threatening side effect following cancer therapy, can be accurately managed and diagnosed. Case Presentation: In the current study, we report the case of a 19-year-old female with a mass on the abdominal wall, diagnosed with ES/PNET. She was treated with the VAC/IE regimen. A month after the last session of chemotherapy, she experienced dyspnea. Upon evaluation, a high level of troponin and a low left ventricular ejection fraction (LVEF) were detected via transthoracic echocardiography. She was treated with anti-heart failure drugs, but the response was unsatisfactory. The possibility of Cancer therapy-related myocarditis was suspected, and cardiac magnetic resonance imaging (CMR) confirmed acute myocarditis. This patient exhibited a significant response to intravenous immunoglobulin (IVIG), with her LVEF improving from 30–35% to 50% within three months. Conclusion: In this case, based on negative tests and the absence of viral signs and symptoms, Cancer therapy-related myocarditis is highly suspected as the cause of myocarditis. This case underscores the importance of accurately utilizing CMR as a non-invasive method for diagnosing myocarditis. It effectively highlights the identification of reversible myocarditis with appropriate treatment and the notable response to IVIG, suggesting its potential as a favorable treatment for myocarditis in younger patients. © The Author(s) 2024.
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