Resolution of sinus bradycardia, high‐grade heart block, and left ventricular systolic dysfunction with rituximab therapy in Henoch‐Schonlein purpura

Henoch‐Schonlein purpura (HSP) is a rare, typically self‐limited, multi‐organ vasculitis. Cardiac involvement with HSP carries high morbidity and mortality, thus requiring early aggressive immunosuppressive therapy. We report a case of HSP complicated with acute systolic left ventricular (LV) dysfun...

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Bibliographic Details
Published in:Internal medicine journal 2018-07, Vol.48 (7), p.868-871
Main Authors: Torosoff, Mikhail, Breen, Thomas, Balulad, Sujata, Padala, Santosh, Lyubarova, Radmila, Tan, Henry, Sidhu, Mandeep
Format: Article
Language:English
Subjects:
arrhythmia
Beta blockers
Bradycardia
Cardiac arrhythmia
Case reports
Corticosteroids
Cyclophosphamide
Electrocardiography
Heart
heart block
Henoch‐Schonlein purpura
Immunosuppressive agents
Immunotherapy
left ventricular systolic dysfunction
Monoclonal antibodies
Morbidity
Renal failure
Rituximab
Schonlein-Henoch purpura
Sinuses
Vasculitis
Ventricle
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Summary:Henoch‐Schonlein purpura (HSP) is a rare, typically self‐limited, multi‐organ vasculitis. Cardiac involvement with HSP carries high morbidity and mortality, thus requiring early aggressive immunosuppressive therapy. We report a case of HSP complicated with acute systolic left ventricular (LV) dysfunction, symptomatic sinus bradycardia and high‐grade atrio‐ventricular (AV) heart block. Cyclophosphamide, a commonly used agent in HSP, was contraindicated due to the patient's presentation with acute renal failure. Treatment with monoclonal antibody rituximab and corticosteroids was initiated with an improvement in and resolution of LV systolic dysfunction, sinus bradycardia and AV block. We believe this is the first published report on rituximab treatment in HSP with cardiac involvement manifesting with severe LV systolic dysfunction, sinus bradycardia and high‐grade AV block.
ISSN:1444-0903
1445-5994
DOI:10.1111/imj.13948