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Telangiectasia and Pulmonary Arterial Hypertension Following Treatment With Trastuzumab Emtansine: A Case Report

Younghoon Kwon, MD; Mardi Gomberg-Maitland, MD; Marc Pritzker, MD; Thenappan Thenappan, MD
Author and Funding Information

FUNDING/SUPPORT: Dr Thenappan is funded by the American Heart Association Scientist Development Grant 15SDG25560048.

CORRESPONDENCE TO: Thenappan Thenappan, MD, Section of Advanced Heart Failure and Pulmonary Hypertension, Cardiovascular Division, University of Minnesota Medical School, 420 Delaware Street SE, MMC 508, Minneapolis, MN 55455


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(4):e103-e105. doi:10.1016/j.chest.2015.09.008
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Trastuzumab emtansine (T-DM1) is a Food and Drug Administration–approved novel agent for the treatment of HER-2 positive advanced breast cancer. We report a case of pulmonary arterial hypertension (PAH) that we attribute to the use of T-DM1. A 43-year-old woman with stage IV breast cancer presented with dyspnea on exertion. After excluding other secondary causes of pulmonary hypertension, a diagnosis of moderately severe PAH was made based on right heart catheterization. History revealed that the patient had been on T-DM1 before presentation. During T-DM1 treatment, the patient experienced hereditary hemorrhagic telangiectasia–like symptoms consisting of spider angiomata-skin lesions, epistaxis, and hematochezia, which resolved with discontinuation of T-DM1. Temporal associations of T-DM1 use with the development of PAH in the patient, and the reported association between hereditary hemorrhagic telangiectasia and PAH via genetic linkage, led us to suspect T-DM1 as the cause of PAH.

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