case_images: PMC11107307_01
case_images: Rituximab infusion rate over time with cardiac events (black circles) corresponding to the events seen in Table 1. Cardiac events occurred at time t = 25, 25.5, and 38 hours.
case_images: 10.1177_23247096241255813-fig1.jpg
case_images: PMC11107307_01_10.1177_23247096241255813-fig1.jpg
case_images: fig1-23247096241255813
case_images: On day 2 evening, the patient started cancer therapy:this involved initiation of rituximab and 1 dose of methotrexate; the exact dosing schedule is seen in Table 1 and visualized in Figure 1.
case_images: Telemetry strips of ventricular tachycardia event at t = 38 hours. Leads are noted in the top left corner, including lead I, III, and V1. The total strip duration is 10 seconds long. There are 13 beats of approximately 4 seconds of non-sustained polymorphic ventricular tachycardia. No fusion complexes or capture beats are noted.
case_images: 10.1177_23247096241255813-fig2.jpg
case_images: PMC11107307_01_10.1177_23247096241255813-fig2.jpg
case_images: fig2-23247096241255813
case_images: On day 2, approximately 21 hours after the once-off methotrexate dose, and approximately 14 hours after rituximab was started and 6 hours it was stopped, the telemetry unit called the oncologist notifying of "13 beats of ventricular tachycardia" (Figure 2). Approximately 6 hours post-rituximab completion, telemetry notified the oncologist of "13 beats of ventricular tachycardia" (Figure 2). Further telemetry strips were reviewed and it was observed that the 13 beats of VT occurred during a 30-second window with another run of 4 betas of non-sustained polymorphic VT, further followed by PVCs (Figure 2).
case_images: Telemetry strips of ventricular tachycardia (VT) event at t = 38 hours. Leads are noted in the top left corner, including lead I, II, and V1. The total strip duration is 30 seconds long (3 rows of 10 seconds each). In the first row of each lead, there are 13 beats of approximately 4 seconds of non-sustained polymorphic VT. No fusion complexes or capture beats are noted. In the second row of each lead, there are 4 beats of approximately 1 second of non-sustained polymorphic VT, followed by 2 pre-ventricular complexes (PVCs). In the third row of each lead, is a PVC, followed by a sinus beat, followed by ventricular bigeminy, followed by a sinus beat.
case_images: 10.1177_23247096241255813-fig3.jpg
case_images: PMC11107307_01_10.1177_23247096241255813-fig3.jpg
case_images: fig3-23247096241255813
case_images: Further events of shorter runs of non-sustained polymorphic VT also occurred (Figure 3).
case_images: ECG recorded 36 minutes after event of non-sustained ventricular tachycardia. ECG shows sinus bradycardia without pre-ventricular complexes.
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case_images: PMC11107307_01_10.1177_23247096241255813-fig4.jpg
case_images: fig4-23247096241255813
case_images: For comparison, there was a post-VT ECG (Figure 4) and ECG 3 months prior to the current admission (Figure 5) that showed sinus bradycardia without PVCs.
case_images: ECG recorded 3 months prior to current admission. ECG shows sinus bradycardia without pre-ventricular complexes.
case_images: 10.1177_23247096241255813-fig5.jpg
case_images: PMC11107307_01_10.1177_23247096241255813-fig5.jpg
case_images: fig5-23247096241255813
case_images: For comparison, there was a post-VT ECG (Figure 4) and ECG 3 months prior to the current admission (Figure 5) that showed sinus bradycardia without PVCs.