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Case Report

Cardiac arrhythmia with premature ventricular

contractures induced by interferon beta in a

patient with multiple sclerosis

Igor Sobol , Marina Sobol , Konstantin E. Balashov 2
1
1
1 Department of Neurology, John F. Kennedy Medical Center, Edison, NJ 08818, USA.
2 Department of Neurology, Rutgers‑Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA.

ABSTRA CT

Multiple sclerosis (MS) is an immune‑mediated inflammatory and neurodegenerative disease of the central nervous system.
Interferon (IFN) beta is an active ingredient of five out of twelve disease modifying treatments approved for MS. We report a case of
IFN‑beta‑induced cardiac arrhythmia with premature ventricular contractures in a patient recently diagnosed with MS.

Key words: Cardiac arrhythmia, interferon beta, multiple sclerosis

INTRODUCTION In June 2008, the patient developed vertigo, dysarthria,
ataxia in the right hand and right hemiparesis. Her
Multiple sclerosis (MS) is an immune-mediated brain magnetic resonance imaging (MRI) revealed
inflammatory and neurodegenerative disease of the numerous ovoid lesions adjacent to lateral ventricles
central nervous system. [1,2] There is no cure for MS. and a T2 hyperintense lesion adjacent to the fourth
Most MS patients are being treated with disease ventricle involving the right middle cerebellar
modifying treatments (DMTs). Selected DMTs can peduncle. Several of these white matter lesions were
cause cardiovascular adverse events in MS patients. contrast-enhancing. On her cervical and thoracic spine
Due to a risk for bradyarrhythmia and atrioventricular MRI, there were two separate contrast-enhancing
blocks, patients should be monitored during fingolimod lesions at C4 and C5-C6 level on the right side. The
[3]
treatment initiation. Interferon (IFN) beta is an active patient improved symptomatically after a course
ingredient of five out of twelve DMTs approved for of intravenous steroids and was diagnosed with
relapsing-remitting form of MS. We are reporting a clinically definite relapsing-remitting MS in 2008
case of IFN-beta-1a-induced cardiac arrhythmia with based on McDonalds criteria. She was initially
[4]
premature ventricular contractures (PVCs) in a patient started on Glatiramer acetate (20 mg subcutaneously
recently diagnosed with MS. daily) in August 2008. However, she had experienced
two MS exacerbations (left optic neuritis and myelitis)
CASE REPORT within 7 months after starting this medication. MRI
done in March 2009 revealed new contrast-enhancing
The patient is a 22-year-old female without any previous lesions in the cervical spine. Therefore, Glatiramer
history of cardiac disease. In 2002, she developed her acetate was discontinued on March 19, 2009 due
first neurological episode of decreased sensation in to the lack of clinical efficacy. She did not take any
the right upper and lower extremities. The symptoms medication between March 19 and April 7. The
subsided after a 5-day course of intravenous steroids. patient agreed to try IFN-beta-1a 3 times a week
and received her first subcutaneous injection of
Access this article online
medication (11 μg, or 25% of the full dose) on April
Quick Response Code: 7, 2009. Three hours after injection, she started to
Website: feel irregular heartbeats. An electrocardiogram (ECG)
www.nnjournal.net
performed on April 8, 2009 revealed PVCs with the
DOI: heart rate 72 beats/min [Figure 1]. IFN-beta was
10.4103/2347-8659.149422 discontinued. The patient was followed clinically; her
symptoms of irregular heartbeats disappeared in 4 days

Corresponding Author: Dr. Konstantin E. Balashov, Department of Neurology, Rutgers‑Robert Wood Johnson Medical School,
125 Paterson Street, Rm 6200, New Brunswick, NJ 08901, USA. E‑mail: konstantin.balashov@rutgers.edu

Neuroimmunol Neuroinflammation | Volume 2 | Issue 1 | January 15, 2015 43