Journal
CUREUS JOURNAL OF MEDICAL SCIENCE
Volume 14, Issue 4, Pages -Publisher
CUREUS INC
DOI: 10.7759/cureus.23789
Keywords
takotsubo cardiomyopathy; adult neurology; transthoracic echocardiogram; pulmonary and critical care medicine; neurology and critical care; disease modifying anti rheumatic drugs; dimethyl fumarate; cardiology; multiple sclerosis and other demyelinating disorders; neuro-immunology
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This article highlights a life-threatening case of DMF-induced takotsubo cardiomyopathy and emphasizes the need for close monitoring of symptoms when initiating disease-modifying drug therapy.
Dimethyl fumarate (DMF) is an approved oral pharmacologic agent used in the treatment of relapsing-remitting multiple sclerosis (RRMS). Although commonly used in clinical practice, its mechanism of action remains largely unknown. Some frequent side effects associated with this drug are angioedema, hepatic injury, flushing, herpes zoster infection, and abdominal pain among others. A 47-year-old female presented with symptoms of an allergic reaction after initiating DMF therapy. She required intensive care unit admission due to an acute-hypoxic respiratory failure. A transthoracic echocardiogram (TTE) revealed apical ballooning and a left ventricular ejection fraction (LVEF) of 35%-40%. A coronary angiogram revealed no coronary artery disease. The diagnosis of takotsubo cardiomyopathy was made. The patient was managed with high-dose steroids and an epinephrine drip, in addition to a high-flow nasal cannula (HFNC) for respiratory support. At a three-month follow-up, a repeat TTE showed a resolution of the underlying takotsubo cardiomyopathy (CM) with no stunted myocardium and a normal ejection fraction (EF). Here, I highlight a life-threatening case of DMF-induced takotsubo CM and familiarize clinicians and patients with the need for close monitoring of symptoms when initiating disease-modifying drug (DMD) therapy.
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