Dilated Cardiomyopathy Secondary to Toxicity from Anthracycline Chemotherapy in a Patient with a History of Acute Lymphoblastic Leukemia: A Case Report

Dilated cardiomyopathy is defined by presence of left ventricular or biventricular dilation and left systolic dysfunction in absence of hypertension, coronary disease, or valvular disease that would justify it. Its causes can be divided into two large groups: those of genetic origin and those of nongenetic origin, which include infectious, toxic, and autoimmune disease causes, among others. Its natural course varies significantly based on the different etiologies and its diagnosis can influence the disease's management and prognosis.

Clinical case: 29-year-old male, with a history of having suffered from Acute Lymphoblastic Leukemia at the age of 4 with complete remission of the disease demonstrated at that time by bone marrow aspirate and immunophenotype, having been treated with anthracyclines. On this occasion, he attended due to the presence of sudden onset dyspnea and hemoptysis, for which in the first instance, due to the previously mentioned history, an attempt was made to rule out pulmonary thromboembolism with chest Angio tomography, which was corroborated by said study and demonstrating the presence of two intracavitary thrombi. Therefore, a transthoracic echocardiogram was performed, highlighting severe dilation of the left ventricle. Management for heart failure was adjusted based on structural alteration demonstrated by echocardiography, with favorable clinical evolution.

Conclusions: The natural history of dilated cardiomyopathy is not easy to establish due to the wide heterogeneity of its etiology and the different rates of progression depending on it. In some cases, there may be functional recovery after acute myocardial damage, for example, in cardiomyopathy induced by tachycardia or in that induced by cardiotoxic drugs. In other cases, stabilization of the disease and systolic dysfunction and, in others, sudden death may be observed.