A case report: rapid progression of coronary atherosclerosis in a patient taking Targretin (Bexarotene)
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A case report: rapid progression of coronary atherosclerosis in a patient taking Targretin (Bexarotene) Sean DeAngelo1* , Kailyn I. Mann2, Muhammad Abdulbasit3, Amy Ahnert2 and Deborah W. Sundlöf4 Abstract Anti-neoplastic drugs have made major advancements in oncology, however they are not without cardiovascular consequences. We present a patient with cutaneous T-cell lymphoma receiving Targretin therapy who presented with accelerated atherosclerosis. His triglyceride level (TG) was greater than 1000 mg/dL, which rapidly improved with discontinuation of Targretin. Keywords: Targretin (Bexarotene), Atherosclerosis, Cutaneous T-cell lymphoma, Atypical angina, Primary hypertriglyceridemia
Clinical history Patient is a 56-year-old male who presented with atypical angina. He has a past medical history of cutaneous T-cell lymphoma (CTCL), type II diabetes, Tourette’s syndrome, mixed hyperlipidemia, former tobacco use disorder, and coronary artery disease status post drug eluding stent (DES) to the right coronary artery (RCA) in 2006. Family history is significant for premature coronary artery disease in his mother. The diagnosis of stage IV CTCL was confirmed by biopsy in 2009. He was subsequently started on narrow band UV-B phototherapy and interferon alpha. Therapy with Targretin was considered but at that time his TG were 458 mg/dL. He was initiated on fenofibrate 48 mg daily, Omega-3 acid ethyl esters 4 g daily and atorvastatin 20 mg daily. His TG level improved 290 mg/dL and 2 months later Targretin was initiated. The following year a PET/CT scan showed transformation of CTCL to Nodal Large Cell Lymphoma. Targretin was discontinued and a regimen of vincristine, * Correspondence: [email protected] 1 University of South Florida/Lehigh Valley Hospital, 1200 South Cedar Crest Blvd, Allentown, PA 18103, USA Full list of author information is available at the end of the article
doxorubicin, and cyclophosphamide was initiated. After 4 cycles, his chemotherapy regimen was advanced to rituximab, ifosfamide, carboplatin, and etoposide. Finally, a combination of methotrexate and cytarabine lead to remission in 2011. The following years, he had multiple relapses and remissions utilizing non-myeloablative stem cell transplant, six cycles of romidepsin, external beam radiation, and nitrogen mustard until systemic therapy with Targretin was restarted in 2015 at 300 mg daily (Fig. 1).
Results In 2016 the patient presented to the Emergency Department with atypical angina. The chest pain was ongoing for weeks and was described as a localized burning sensation without radiation. The pain occurred sporadically with both rest and exertion, lasting minutes and resolving spontaneously. Troponins were negative and a Dobutamine stress echocardiogram was negative for ischemia. He reported “heart burn” at peak Dobutamine infusion that resolved after drinking soda. He was seen in the cardiology office for follow up and reported persistent symptoms. Given his risk factors and continued chest pain syndrome, a
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