A case of COVID-19 masquerading as presumed Trastuzamab induced
subclinical cardiotoxicity
Abstract
A 48-year-old woman was diagnosed with right-sided Grade 2 invasive
breast carcinoma. Prior to initiation of chemotherapy, transthoracic
echocardiogram (TTE) demonstrated normal systolic function with left
ventricular ejection fraction (LVEF) 64% and global longitudinal strain
(GLS) 21%. Following adjuvant chemotherapy with four cycles of
anthracycline, twelve cycles of Paclitaxel, and two cycles of
Trastuzamab chemotherapies, TTE demonstrated reduction in LVEF to 56%
and GLS of -18% (14% relative reduction compared to baseline). Further
investigation revealed recent symptomatic COVID-19 infection coinciding
with functional impairment and decision was made to continue Trastuzumab
therapy without cardioprotective agents. Subsequent TTE demonstrated
improved systolic function, indicating the importance of taking history
of significant viral infections during chemotherapy standard of care.