Takotsubo Cardiomyopathy Due to Diffuse Large B-Cell Lymphoma-Associated Hemophagocytic Lymphohistiocytosis

Juka S Kim; Angela Ai; Kathryn H Melamed

doi:10.1016/j.jaccas.2025.103691

Takotsubo Cardiomyopathy Due to Diffuse Large B-Cell Lymphoma-Associated Hemophagocytic Lymphohistiocytosis

JACC Case Rep. 2025 Jun 18;30(15):103691. doi: 10.1016/j.jaccas.2025.103691.

Authors

Juka S Kim¹, Angela Ai², Kathryn H Melamed³

Affiliations

¹ Department of Medicine, Stanford University, Stanford, California, USA.
² Department of Medicine, Olive View-UCLA Medical Center, Los Angeles, California, USA.
³ Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California, USA. Electronic address: kmelamed@mednet.ucla.edu.

Abstract

Background: Takotsubo cardiomyopathy (TCM) is a self-limited cardiomyopathy that improves with treatment of the underlying etiology. Although previously recognized as a transient and benign cardiomyopathy, the incidence of TCM continues to rise with increasing evidence for life-threatening complications such as cardiogenic shock.

Case summary: We present the first reported case of a 56-year-old woman with cardiogenic shock from TCM due to hemophagocytic lymphohistiocytosis (HLH) secondary to Epstein-Barr Virus (EBV) associated diffuse large B-cell lymphoma (DLBCL). Treatment with DLBCL-directed chemotherapy during critical illness resulted in resolution of her acute cardiomyopathy and shock.

Discussion: As in our case, the acute cytokine storm in HLH may result in TCM, a finding emphasizing the importance of assessing cardiac function in this patient cohort.

Take-home message: This case highlights the importance of considering the risk of cardiomyopathy in patients with HLH.

Keywords: acute heart failure; cardiomyopathy; echocardiography; reduced ejection fraction.

Publication types

Case Reports