Work

Cyclophosphamide-Induced Hemorrhagic Myocarditis

Year: 2026

Type: article

Abstract: 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.

Source: JACC Case Reports

DOI: 10.1016/j.jaccas.2025.106613

Authors: Rade R. Jibawi Rivera, David M. Harmon, Joerg Herrmann, Patricia A. Pellikka

Institution: Mayo Clinic

Language: English

Topic: Chemotherapy-induced cardiotoxicity and mitigation

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $850