DISFUNÇÃO MIOCÁRDICA AGUDA ASSOCIADA AO RITUXIMABE EM UM PACIENTE COM ESCLEROSE MÚLTIPLA DO TIPO SCHILDER: RELATO DE CASO
DOI:
https://doi.org/10.56238/levv17n56-006Palavras-chave:
Esclerose Múltipla, Rituximabe, Cardiotoxicidade, Anticorpos Monoclonais, Relato de CasoResumo
Introdução: O rituximabe é um anticorpo monoclonal anti-CD20 amplamente utilizado no tratamento de doenças autoimunes e hematológicas, incluindo o uso off-label em formas agressivas de esclerose múltipla. Embora seu perfil geral de segurança seja considerado favorável, eventos adversos cardiovasculares raros e potencialmente graves têm sido cada vez mais relatados, especialmente à medida que seu uso se expande para além do contexto oncológico.
Objetivo: Relatar um caso de disfunção miocárdica aguda temporalmente associada à infusão de rituximabe em uma paciente jovem com esclerose múltipla do tipo Schilder e sem histórico prévio de doença cardíaca, bem como discutir suas implicações clínicas.
Métodos: Trata-se de um relato de caso baseado na revisão retrospectiva de dados clínicos, laboratoriais, eletrocardiográficos e ecocardiográficos obtidos do prontuário eletrônico, complementada por uma revisão narrativa da literatura recente sobre cardiotoxicidade associada a anti-CD20.
Relato de caso: Paciente do sexo feminino, 30 anos, com esclerose múltipla do tipo Schilder, desenvolveu dor torácica súbita durante a infusão de rituximabe, associada a elevação acentuada dos níveis de troponina cardíaca e disfunção sistólica do ventrículo esquerdo documentada por ecocardiografia. A infusão foi imediatamente interrompida e instituída terapia padrão para insuficiência cardíaca, resultando em melhora clínica e recuperação da função cardíaca. Em decorrência do evento adverso, a terapia imunomoduladora foi posteriormente modificada.
Conclusão: Este caso sugere uma associação entre o uso de rituximabe e disfunção miocárdica aguda, mesmo em pacientes jovens sem fatores de risco cardiovasculares tradicionais. Ressalta-se a importância do reconhecimento precoce de eventos adversos raros, do monitoramento adequado durante as infusões e do manejo multidisciplinar para aumentar a segurança das terapias imunobiológicas.
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