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Peer-reviewedCC BY-NC-ND 4.0JACC Case Reports

Late Anthracycline Cardiotoxicity Mimicking Arrhythmogenic Cardiomyopathy in a Young Adult

  • Maroun Chedid1,2
  • Collin Barrett1,2
  • Melanie Sun2
  • Andrew Lesser1
  • Katarxyna Hryniewicz1,2
  1. 1Allina Health Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
  2. 2Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
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Abstract

Background: Doxorubicin-induced cardiotoxicity can manifest years after exposure and may mimic other cardiomyopathies in young patients, making the diagnosis of delayed doxorubicin cardiotoxicity challenging in these patients.

Case Summary: A 26-year-old physically active man with childhood Burkitt’s lymphoma treated with doxorubicin (120 mg/m2 cumulative) presented with exertional chest discomfort and palpitations. Resting electrocardiogram and ambulatory monitoring were unremarkable. Transthoracic echocardiography demonstrated preserved ejection fraction (55%-60%) but reduced global longitudinal strain (−15%). Cardiac magnetic resonance revealed low-normal biventricular function with nonischemic septal late gadolinium enhancement and reduced strain. Exercise stress testing demonstrated impaired contractile reserve, septal mechanical dyssynchrony, and exercise-induced QRS prolongation. Coronary computed tomography angiography excluded coronary artery disease.

Discussion: This case highlights that anthracycline cardiotoxicity may present late, mimic myocardial ischemia, arrhythmogenic cardiomyopathy, and other cardiomyopathies.

Take-Home Message: A high index of suspicion is required for late cardiotoxicity in young cancer survivors.

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Cite

BibTeXRIS
BibTeX
@article{chedid2026late,
  title = {{Late Anthracycline Cardiotoxicity Mimicking Arrhythmogenic Cardiomyopathy in a Young Adult}},
  author = {Maroun Chedid and Collin Barrett and Melanie Sun and Andrew Lesser and Katarxyna Hryniewicz},
  journal = {JACC Case Reports},
  year = {2026},
  month = sep,
  doi = {10.1016/j.jaccas.2026.110273},
  url = {https://doi.org/10.1016/j.jaccas.2026.110273},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Late Anthracycline Cardiotoxicity Mimicking Arrhythmogenic Cardiomyopathy in a Young Adult
AU  - Maroun Chedid
AU  - Collin Barrett
AU  - Melanie Sun
AU  - Andrew Lesser
AU  - Katarxyna Hryniewicz
PY  - 2026
DA  - 2026/09/11
JO  - JACC Case Reports
DO  - 10.1016/j.jaccas.2026.110273
UR  - https://doi.org/10.1016/j.jaccas.2026.110273
AB  - Background: Doxorubicin-induced cardiotoxicity can manifest years after exposure and may mimic other cardiomyopathies in young patients, making the diagnosis of delayed doxorubicin cardiotoxicity challenging in these patients.  Case Summary: A 26-year-old physically active man with childhood Burkitt’s lymphoma treated with doxorubicin (120 mg/m2 cumulative) presented with exertional chest discomfort and palpitations. Resting electrocardiogram and ambulatory monitoring were unremarkable. Transthoracic echocardiography demonstrated preserved ejection fraction (55%-60%) but reduced global longitudinal strain (−15%). Cardiac magnetic resonance revealed low-normal biventricular function with nonischemic septal late gadolinium enhancement and reduced strain. Exercise stress testing demonstrated impaired contractile reserve, septal mechanical dyssynchrony, and exercise-induced QRS prolongation. Coronary computed tomography angiography excluded coronary artery disease.  Discussion: This case highlights that anthracycline cardiotoxicity may present late, mimic myocardial ischemia, arrhythmogenic cardiomyopathy, and other cardiomyopathies.  Take-Home Message: A high index of suspicion is required for late cardiotoxicity in young cancer survivors.
SN  - 2666-0849
ER  -