SHM Converge Scientific Abstract ePoster Gallery-Transient Chorea Secondary to Digoxin Use in Chronic Kidney Disease

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This case report describes a 54-year-old man with heart failure with reduced ejection fraction, chronic kidney disease, and atrial fibrillation who developed transient generalized chorea after accidentally taking extra digoxin. He presented with 2 weeks of fatigue, weakness, vomiting, poor oral intake, and involuntary sudden movements affecting the whole body. Exam showed symmetric choreiform movements, most prominent in the head, upper torso, and arms, with otherwise normal neurologic findings.<br /><br />Laboratory tests revealed markedly elevated digoxin level (5.0 ng/mL), worsened renal function (creatinine 2.7 mg/dL from baseline 1.6), mild hyponatremia, mild hyperkalemia, and elevated BUN. CT head showed no basal ganglia lesion or other structural cause of chorea. The patient’s sertraline and mirtazapine were continued, making them less likely contributors.<br /><br />He was treated with fluids, correction of metabolic abnormalities, discontinuation of digoxin, and two doses of digoxin-specific antibody fragments (DigiFab). His chorea improved by hospital day 2 as digoxin levels fell, and completely resolved by day 3 when the level normalized to 1 ng/mL.<br /><br />The report highlights that chorea can be a rare manifestation of digoxin toxicity, even without classic cardiac symptoms. Chronic kidney disease increases the risk of digoxin toxicity because the drug has a narrow therapeutic window and is cleared partly through the kidneys. The exact mechanism linking digoxin to chorea is not fully known, though altered dopamine signaling has been proposed. The authors conclude that digoxin was the most likely cause of this patient’s movement disorder and emphasize the need for larger studies to better define how often this occurs, why it happens, and how it should be managed.

Asset Subtitle

Mina Sitto

Meta Tag

Author List Cristina Jageka, Mina Sitto, Sulafa Saffarini, Syeda Maria Muzammil

Category Clinical Vignettes

Concept Chorea

Concept Digoxin Toxicity

Concept Digoxin-Specific Antibody Fragments

Concept Basal Ganglia Dysfunction

Concept Renal Disease

Distinguished Non-Finalist

Presenter Organization Wayne State University School of Medicine

Presenting Author Mina Sitto

Track Adult

Keywords

digoxin toxicity

chorea

heart failure with reduced ejection fraction

chronic kidney disease

atrial fibrillation

digoxin-specific antibody fragments

DigiFab

elevated digoxin level

movement disorder

renal impairment

Chorea

Digoxin Toxicity

Digoxin-Specific Antibody Fragments

Basal Ganglia Dysfunction

Renal Disease