Updated cardiac concerns with rituximab use: A growing challenge

A 62-year-old male was undergoing treatment of NHL with bone marrow involvement with thrombocytopenia. After 15 min of starting of IV infusion of rituximab, he started having severe retrosternal chest pain, diagnosed as acute ST elevation inferior wall MI. Patient was pre-loaded with dual anti platelets. Coronary angiogram showed 100% occlusion of proximal RCA. Thrombosuction of this culprit RCA revealed underlying 90% stenosis. After that, PCI with balloon angioplasty of RCA was done. The procedure was terminated in the view of successful balloon angioplasty with good TIMI flow. He was kept on dual antiplatelet therapy for one month with regular platelet monitoring. With the growing increasing global use of rituximab for various oncological and immunological diseases, this complication of myocardial infarction should be kept in mind. Associated thrombocytopenia with high thrombus burden in this case heed primary coronary balloon angioplasty without stent placement a more suitable modality.