Hydroxychloroquine-Induced Myopathy Responding to Intravenous Immunoglobulin (IVIG)

Abstract and Figures

Hydroxychloroquine (HCQ), a drug used to treat many diseases such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), has limited reports documenting drug-induced myopathies as a side effect. This entity is underdiagnosed with unclear treatment interventions apart from discontinuing the offending drug. We report a case of a biopsy-proven hydroxychloroquine-induced myopathy in a 35-year-old female patient with SLE. The offending drug was stopped, but the patient did not improve. However, she showed marked improvement after the use of intravenous immunoglobulin (IVIG). ## Keywords hydroxychloroquine; hydroxychloroquine-induced myopathy; ivig; myopathy; systemic lupus erythematosus.

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Key Words

hydroxychloroquine; hydroxychloroquine-induced myopathy; ivig; myopathy; systemic lupus erythematosus.

Conflict of interest statement

The authors have declared that no competing interests exist. cureus-0015-00000041016-i01.jpg cureus-0015-00000041016-i02.jpg

References

  • Systematic review and meta-analysis of the safety of chloroquine and hydroxychloroquine from randomized controlled trials on malarial and non-malarial conditions. Souza Botelho M, Bolfi F, Leite RG, et al. Syst Rev. 2021;10:294. - PMC - PubMed
  • Antimalarial myopathy in a systemic lupus erythematosus patient with quadriparesis and seizures: a case-based review. Jafri K, Zahed H, Wysham KD, Patterson S, Nolan AL, Bucknor MD, Chaganti RK. Clin Rheumatol. 2017;36:1437–1444. - PubMed
  • Safety management in treatment with antimalarials in rheumatology. Interdisciplinary recommendations on the basis of a systematic literature review. Fiehn C, Ness T, Weseloh C, Specker C, Hadjiski D, Detert J, Krüger K. Z Rheumatol. 2021;80:1–9. - PubMed
  • Acute chloroquine and hydroxychloroquine toxicity: a review for emergency clinicians. Della Porta A, Bornstein K, Coye A, Montrief T, Long B, Parris MA. Am J Emerg Med. 2020;38:2209–2217. - PMC - PubMed
  • Hydroxychloroquine-induced toxic myopathy causing respiratory failure. Siddiqui AK, Huberfeld SI, Weidenheim KM, Einberg KR, Efferen LS. Chest. 2007;131:588–590. - PubMed
  • Side effects of chloroquine and hydroxychloroquine on skeletal muscle: a narrative review. Carvalho AA. Curr Pharmacol Rep. 2020;6:364–372. - PMC - PubMed
  • The toxic effects of chloroquine and hydroxychloroquine on skeletal muscle: a systematic review and meta-analysis. Biguetti CC, Junior JF, Fiedler MW, Marrelli MT, Brotto M. Sci Rep. 2021;11:6589. - PMC - PubMed
  • Antimalarial myopathy: an underdiagnosed complication? Prospective longitudinal study of 119 patients. Casado E, Gratacós J, Tolosa C, et al. Ann Rheum Dis. 2006;65:385–390. - PMC - PubMed
  • Revised recommendations on screening for chloroquine and hydroxychloroquine retinopathy. Marmor MF, Kellner U, Lai TY, Lyons JS, Mieler WF. Ophthalmology. 2011;118:415–422. - PubMed
  • Hydroxychloroquine in systemic lupus erythematosus: overview of current knowledge. Dima A, Jurcut C, Chasset F, Felten R, Arnaud L. Ther Adv Musculoskelet Dis. 2022;14:1759720. - PMC - PubMed
  • Curvilinear bodies are associated with adverse effects on muscle function but not with hydroxychloroquine dosing. Khoo T, Otto S, Smith C, Koszyca B, Lester S, Blumbergs P, Limaye V. Clin Rheumatol. 2017;36:689–693. - PubMed
  • Intravenous immune globulin for statin-triggered autoimmune myopathy. Mammen AL, Tiniakou E. N Engl J Med. 2015;373:1680–1682. - PMC - PubMed
  • Clinical applications of immunoglobulin in neuromuscular diseases: focus on inflammatory myopathies. Souza PV, Pinto WB, Oliveira AS. Arq Neuropsiquiatr. 2014;72:966–971. - PubMed 
Dr. Ahmad Fallata
Published: May 5, 2023

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