Intracardiac thrombosis following intravenous zoledronate treatment in a child with steroid-induced osteoporosis

Samantha J. Case; Rebecca J. Moon; Tara Bharucha; Justin H. Davies

doi:10.1515/jpem-2022-0475

Article

Intracardiac thrombosis following intravenous zoledronate treatment in a child with steroid-induced osteoporosis

Samantha J. Case , Rebecca J. Moon , Tara Bharucha and Justin H. Davies

Published/Copyright: November 28, 2022

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From the journal Journal of Pediatric Endocrinology and Metabolism Volume 36 Issue 3

Abstract

Objectives

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.

Case presentation

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.

Conclusions

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.

Keywords: bisphosphonate; intracardiac thrombosis; steroid induced osteoporosis

Corresponding author: Dr. Rebecca J. Moon, NIHR Academic Clinical Lecturer in Child Health, Paediatric Endocrinology, Southampton Children’s Hospital, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, Hampshire, SO16 6YD, UK; and MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK, E-mail: rm@mrc.soton.ac.uk

Samantha J. Case and Rebecca J. Moon are joint first authors.

Acknowledgments

We thank the patient and his family for consent to publish details of their medical case and accompanying images.

Research funding: No specific funding for this study received. RJM is funded by an NIHR Academic Clinical Lectureship.
Author contributions: SJC and RJM drafted the initial manuscript, critically reviewed, and revised the manuscript. TB and JHD contributed to the care of the patient, critically reviewed and revised the manuscript. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: RJM has received travel bursaries from Kyowa Kirin. JHD has received travel bursaries from Novo Nordisk, honoraria from Kyowa Kirin. SJC and TB have no conflicts of interest to declare.
Informed consent: Written informed consent was obtained from patient and their parent for publication of the details of their medical case and the accompanying images.
Ethical approval: Ethical approval not required.

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Received: 2022-09-20

Accepted: 2022-11-11

Published Online: 2022-11-28

Published in Print: 2023-03-28

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Articles in the same Issue

https://doi.org/10.1515/jpem-2022-0475

Keywords for this article

bisphosphonate; intracardiac thrombosis; steroid induced osteoporosis