Rapid and life-threatening heart failure induced by pazopanib

A 70-year-old man with history of stage IV renal cell carcinoma, chronic atrial fibrillation on warfarin, coronary artery disease status post-percutaneous coronary intervention resulting in an ischaemic cardiomyopathy with left ventricular ejection fraction of 40%–45%, presented with shortness of br...

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Bibliographic Details
Published in:BMJ case reports 2018-08, Vol.2018, p.bcr-2018-225613
Main Authors: Wang, Haotong, Rodriguez-Pla, Alicia, Campagna, Anthony
Format: Article
Language:English
Subjects:
Aged
Antineoplastic Agents - adverse effects
Blood pressure
Carcinoma, Renal Cell - drug therapy
Cardiac arrhythmia
Cardiomyopathy
Cardiovascular disease
Case reports
Dyspnea
Ejection fraction
Electrolytes
Heart failure
Heart Failure - chemically induced
Heart rate
Humans
Hypertension
Inhibitor drugs
Kidney cancer
Kidney Neoplasms - drug therapy
Male
Metastasis
Patients
Pneumonia
Pulmonary arteries
Pyrimidines - adverse effects
Sulfonamides - adverse effects
Targeted cancer therapy
Unexpected Outcome (Positive or Negative) Including Adverse Drug Reactions
Vascular endothelial growth factor
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Summary:A 70-year-old man with history of stage IV renal cell carcinoma, chronic atrial fibrillation on warfarin, coronary artery disease status post-percutaneous coronary intervention resulting in an ischaemic cardiomyopathy with left ventricular ejection fraction of 40%–45%, presented with shortness of breath 10 days after starting pazopanib. Within the first week of starting pazopanib, the patient developed fatigue and progressive dyspnoea on exertion. His symptoms quickly worsened and he had compromised mental status. He was transferred to the intensive care unit (ICU) and intubated due to continued respiratory distress. He was found to be in cardiogenic shock and was started on inotropic support with dobutamine and norepinephrine. With maximum support, the patient was slowly weaned off vasopressors and was successfully extubated on ICU day 9. His hospital stay lasted 29 days with management of multiple medical complications, and he was eventually discharged to a rehabilitation facility.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2018-225613