Intracardiac thrombosis following intravenous zoledronate treatment in a child with steroid-induced osteoporosis
Intracardiac thrombosis following intravenous zoledronate treatment in a child with steroid-induced osteoporosis
Bisphosphonates are used in childhood osteoporosis but can cause an acute phase reaction (APR) and hypocalcemia. We present a child with cardiac thrombosis following zoledronate, a previously unreported complication. An 11-year-old with Duchenne muscular dystrophy and steroid-induced osteoporosis presented 48 h after first zoledronate infusion with fever, tachycardia, tachypnoea and hypoglycaemia. This was managed as acute adrenal crisis and possible sepsis. He also had hypocalcemia, hypophosphatemia, hyponatraemia and hypokalaemia. Echocardiography performed due to persistent chest pain and tachycardia revealed a left ventricular thrombus. Potential causes for intracardiac thrombosis in this patient include ventricular dysfunction due to acute adrenal crisis or electrolyte disturbance, and hypercoagulability due to the APR. Echocardiography should be considered in children with acute cardiovascular compromise following zoledronate. Stress-dose steroids to cover the APR and a reduced starting dose of zoledronate might have reduced the risk of this complication.
bisphosphonate, intracardiac thrombosis, steroid induced osteoporosis
Case, Samantha J.
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Moon, Rebecca J.
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Bharucha, Tara
09d91988-7a3a-4814-84cb-da0c733b4ff8
Davies, Justin H.
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Case, Samantha J.
043e8e18-fa9d-4068-b63d-72cdfbf11b93
Moon, Rebecca J.
16ba3d3f-010f-4b11-a9c2-635979a27f4a
Bharucha, Tara
09d91988-7a3a-4814-84cb-da0c733b4ff8
Davies, Justin H.
9f18fcad-f488-4c72-ac23-c154995443a9
Case, Samantha J., Moon, Rebecca J., Bharucha, Tara and Davies, Justin H.
(2022)
Intracardiac thrombosis following intravenous zoledronate treatment in a child with steroid-induced osteoporosis.
Journal of Pediatric Endocrinology and Metabolism.
(doi:10.1515/jpem-2022-0475).
Abstract
Bisphosphonates are used in childhood osteoporosis but can cause an acute phase reaction (APR) and hypocalcemia. We present a child with cardiac thrombosis following zoledronate, a previously unreported complication. An 11-year-old with Duchenne muscular dystrophy and steroid-induced osteoporosis presented 48 h after first zoledronate infusion with fever, tachycardia, tachypnoea and hypoglycaemia. This was managed as acute adrenal crisis and possible sepsis. He also had hypocalcemia, hypophosphatemia, hyponatraemia and hypokalaemia. Echocardiography performed due to persistent chest pain and tachycardia revealed a left ventricular thrombus. Potential causes for intracardiac thrombosis in this patient include ventricular dysfunction due to acute adrenal crisis or electrolyte disturbance, and hypercoagulability due to the APR. Echocardiography should be considered in children with acute cardiovascular compromise following zoledronate. Stress-dose steroids to cover the APR and a reduced starting dose of zoledronate might have reduced the risk of this complication.
Text
Cardiac thrombosis JPEM revision - Endnote codes removed
- Accepted Manuscript
More information
Accepted/In Press date: 11 November 2022
e-pub ahead of print date: 28 November 2022
Additional Information:
Funding Information:
Research funding: No specific funding for this study received. RJM is funded by an NIHR Academic Clinical Lectureship.
Publisher Copyright:
© 2022 Walter de Gruyter GmbH, Berlin/Boston.
Keywords:
bisphosphonate, intracardiac thrombosis, steroid induced osteoporosis
Identifiers
Local EPrints ID: 473225
URI: http://eprints.soton.ac.uk/id/eprint/473225
ISSN: 0334-018X
PURE UUID: 9a0c0a08-5d31-4a3a-8b54-fea2eb4e9a43
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Date deposited: 12 Jan 2023 18:06
Last modified: 17 Mar 2024 07:36
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Author:
Samantha J. Case
Author:
Rebecca J. Moon
Author:
Tara Bharucha
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