TEMPORARY HEART FAILURE ASSOCIATED WITH LONG-TERM DAILY ORAL CYCLOPHOSPHAMIDE USE IN A PATIENT WITH WEGENER’S GRANULOMATOSIS

Dear Sir, Wegener’s Granulomatosis (WG) is a necrotising, granulomatous small-vessel vasculitis associated with anti-neutrophil cytoplasmic antibodies (ANCA) typically affecting the upper and lower airways and, in some cases, the kidneys (1, 2). Involvement of vital organs, such as severe pulmonary or renal involvement, requires aggressive immunosuppressive treatment (2). Cyclophosphamide (Cyc), an immunosuppressive agent, is often used when vital organs are involved (2). Cyc therapy has severe side effects, some of which are bone marrow suppression and associated infections, hemorrhagic cystitis, gonadal damage and malignancy (3, 4). Cardiomyopathy may occur in some patients treated with high-dose intravenous Cyc in a short period, and is shown to be dose related (5, 6). To the best of our knowledge, Cyc cardiotoxicity resulting from long-term daily oral cyclophosphamide use has not been previously reported.