A Young Patient Presenting with Dilated Cardiomyopathy and Renal Infarction during Treatment with Isotretinoin: Mere Coincidence or Serious Side Effect of a Drug Commonly Used in Adolescence?
Martino PepeGianluigi NapoliMaria Cristina CarellaDaniele De FeoRocco TrittoAndrea Igoren GuaricciCinzia ForleoMarco Matteo CicconePublished in: Diagnostics (Basel, Switzerland) (2023)
Isotretinoin or 13-cis-retinoic acid (RA) is one of the most effective and widely used drugs for the treatment of severe acne vulgaris. Despite being deemed safe, no definite consensus has been reached on the cardiovascular risk of RA derivatives. We report a case of heart failure due to dilated cardiomyopathy (DCM) and concomitant renal infarction occurring after 5 months of isotretinoin use in a previously healthy 18-year-old male. The patient, with a history of acne vulgaris, presented to our emergency department with left iliac fossa pain and effort dyspnea. A trans-thoracic echocardiogram showed DCM and severely reduced left ventricle ejection fraction (LVEF: 29%). During hospitalization, a total body computed tomography (CT) showed an ischemic lesion in the left kidney. Ischemic, autoimmune, infective, and heritable causes of DCM were ruled out. Cardiac magnetic resonance (CMR) evidenced LV circumferential mid-wall late gadolinium enhancement. Heart failure therapy was promptly started and up-titrated, but only poor LVEF improvement was detected overtime. Our case aims to raise awareness on rare life-threatening cardiovascular events possibly associated with isotretinoin use. To the best of our knowledge, this is the first described case of renal thromboembolism and severe DCM leading to implantable cardioverter-defibrillator (ICD) implantation occurring during isotretinoin treatment.
Keyphrases
- heart failure
- cardiovascular events
- computed tomography
- ejection fraction
- emergency department
- magnetic resonance
- case report
- contrast enhanced
- left ventricular
- positron emission tomography
- coronary artery disease
- rheumatoid arthritis
- healthcare
- cardiovascular disease
- atrial fibrillation
- early onset
- spinal cord
- disease activity
- combination therapy
- ankylosing spondylitis
- aortic stenosis
- image quality
- systemic lupus erythematosus
- ischemia reperfusion injury
- cardiac resynchronization therapy
- neuropathic pain
- chronic pain
- spinal cord injury
- dual energy
- oxidative stress
- type diabetes
- cerebral ischemia
- replacement therapy
- smoking cessation