Cessation of the culprit drug, along with aggressive afterload reduction therapy, has been associated with halting of disease progress and even improvement in patients' clinical and histologic status. (B) Doppler tissue imaging of lateral mitral annulus documents Ea 7.2cm/s and Aa velocity 2.7cm/s. (C) Pulsed Doppler of mitral inflow demonstrates left ventricular restrictive physiology. At presentation (left) electron micrograph (magnification ×11000) shows central replacement and displacement of sarcomeres by marked accumulation of secondary lysosomes including myeloid bodies (MB) and curvilinear bodies (CL). Echocardiography is a fundamental tool in the identification and assessment of patients with cardiomyopathy, with particular utility in the detailed assessment of biventricular systolic and diastolic function. This appearance is typical and characteristic of chloroquine and hydroxychloroquine toxicity. Chloroquine diphosphate salt sigma solubility Plaquenil treatment rheumatoid arthritis Safe to take plaquenil with antacids Hydroxychloroquine HCQ is a 4-aminoquinoline which differs from chloroquine CQ in the addition of a hydroxyl group. Initially used as antimalarials, both drugs have now become mainstays in the management of rheumatic diseases principally systemic lupus erythematosus SLE and rheumatoid arthritis RA. Diagnosis of Drug-induced Myopathies. A drug-induced, or toxic, myopathy is defined as the acute or subacute manifestation of myopathic symptoms such as muscle weakness, myalgia, creatine kinase CK elevation, or myoglobinuria that can occur in patients without muscle disease when they are exposed to certain drugs 1. Hydroxychloroquine myopathy. DISCUSSION Hydroxychloroquine HCQ, a commonly used drug for various autoimmune conditions, is widely distributed into cardiac and skeletal muscle tissue. We present a case of a 51-year-old woman with hydroxychloroquine-induced restrictive cardiomyopathy and correlate clinical, echocardiographic and anatomic pathologic findings both at initial presentation and following treatment. Electron micrograph (magnification ×6700) shows normal myocyte ultrastructure with secondary lysosomes that would appear by light microscopy as lipofuscin pigment. Difference between A duration (tricuspid) and A duration (hepatic vein flow)=70ms." path-from-xml="8-4-247-fig3.jpeg" /Echocardiographic findings at 2 years. It also provides an objective and non-invasive means of assessing treatment response. (F) Pulsed Doppler of hepatic vein flow shows blunting of systolic flow with prominent atrial flow reversals in both inspiration and expiration. At 2 years (right) myocardial biopsy shows near complete resolution of electron microscopic findings of hydroxychloroquine toxicity. (D) Pulsed Doppler of pulmonary vein flow shows normal forward flow characteristics (systolic velocitydiastolic velocity) but with persisting prominent atrial flow reversals in both inspiration and expiration. Plaquenil myopathy Hydroxychloroquine Causes Severe Vacuolar Myopathy in a., Drug-related Myopathies of Which the Clinician Should Be Aware What does aralen doPlaquenil a steroidHydroxychloroquine and leflunomide togetherHydroxychloroquine normal dose range CMR may serve as an increasingly important diagnostic modality in antimalarial cardiotoxicity for a number of reasons. Firstly, it is the reference standard for the assessment of LV and RV function and morphology, the latter also commonly abnormal in antimalarial cardiotoxicity. 7,11 –13,17,18 Secondly, CMR also plays a primary role in the exclusion of differential diagnoses. Hydroxychloroquine cardiotoxicity presenting as a. Final Diagnosis -- Hydroxychloroquine myopathy -. HYDROXYCHLOROQUINE PLAQUENIL CARDIOTOXICITY AN UNCOMMON.. Sep 13, 2019 Frequency not reported Skeletal muscle myopathy or neuromyopathy leading to progressive weakness and atrophy of proximal muscle groups, depression of tendon reflexes and abnormal nerve conduction studies. Myopathy may be reversible after therapy discontinuation, but recovery may take many months. Nervous system Chloroquine Hydroxychloroquine-induced cardiomyopathy is a rare but potentially life-threatening condition. Cessation of the culprit drug, along with aggressive afterload reduction therapy, has been associated with halting of disease progress and even improvement in patients' clinical and histologic status. The molecular weight of hydroxychloroquine sulfate is 433.95, and molecular formula is C 18 H 26 ClN 3 O. H 2 SO 4. Plaquenil hydroxychloroquine sulfate tablets contain 200 mg hydroxychloroquine sulfate, equivalent to 155 mg base, and are for oral administration.