Recovery from severe adriamycin-induced cardiomyopathy after prolonged intensive care in a patient with uterine leiomyosarcoma: A case report.

Adriamycin (ADM) is an anthracycline widely used to treat various malignancies, including uterine leiomyosarcoma; however, cumulative dose-dependent cardiotoxicity can lead to life-threatening cardiomyopathy. Although ADM-induced cardiomyopathy has long been considered irreversible, it has been suggested that early treatment and intensive care may allow recovery in relatively mild-to-moderate heart failure (HF). By contrast, recovery of cardiac function in patients with extremely severe ADM-induced cardiomyopathy, particularly those with a left ventricular ejection fraction (LVEF) of <20% complicated by cardiogenic shock and multiorgan dysfunction requiring prolonged intensive care, is rare. The present study describes a case of severe ADM-induced cardiomyopathy following adjuvant chemotherapy for uterine leiomyosarcoma, highlighting the unexpected recovery observed after prolonged intensive care and stepwise HF management. A 40-year-old woman underwent surgical resection of a uterine leiomyosarcoma, followed by adjuvant ADM chemotherapy (cumulative dose, 450 mg/m2). A total of 3 months after completing chemotherapy, the patient developed progressive dyspnea and fatigue, which was initially attributed to a common cold, and then presented with acute HF. When the patient visited the emergency department, echocardiography confirmed severe systolic dysfunction with an LVEF of 15%. Prolonged intensive care with advanced pharmacological and supportive therapies, including multiple cardiotonic drugs, vasopressors and cardioprotective medications, was required. Despite escalation of care, their condition deteriorated to cardiogenic shock with multiorgan dysfunction, prompting a do-not-resuscitate order. However, through sustained intensive management over several months, cardiac function gradually improved. Inotropic support was systematically withdrawn and the patient was transitioned to oral HF medications. After ~5 months of hospitalization, the patient was discharged. At the 6-month follow-up, their LVEF recovered to 57% and the patient returned to normal life. In conclusion, extremely severe ADM-induced cardiomyopathy may be reversible; this case highlights the potential for recovery despite multiple unfavorable prognostic factors under extended, intensive HF management.