Authors
Khalid Ghalib, Ahmed Elnour, Nada Eltigani Hassan Mahgoub, Mohamed Ali, Pedro Arregui
Published in
Cureus. Volume 18. Issue 8. Pages e115495. Epub Aug 31, 2026.
Abstract
Ibrutinib, an irreversible inhibitor of Bruton's tyrosine kinase (BTK), is a cornerstone of therapy for low-grade B-cell lymphoproliferative disorders (B-cell LPD), including Waldenstrom's macroglobulinaemia (WM). While highly effective, its adverse effect profile is broad and potentially life-threatening, particularly in elderly patients with multiple comorbidities. We report an 82-year-old woman with a seven-year history of CD5-negative low-grade B-cell LPD and IgM paraproteinaemia, managed sequentially with rituximab and ibrutinib. During ibrutinib therapy, she developed a cascade of complications, including recurrent infections, platelet dysfunction, new-onset paroxysmal atrial fibrillation (AF), and haemothorax following a fall and pericardial tamponade requiring urgent pericardiocentesis. The concurrent prescription of apixaban for AF and clarithromycin for lower respiratory tract infection (LRTI) created critical drug interaction hazards. A review of her clinical course suggests that ibrutinib may have been the unifying causative agent across multiple organ systems. This case highlights the importance of vigilant monitoring for ibrutinib-associated adverse events in elderly patients, the complexity of anticoagulation decisions in the setting of ibrutinib-induced AF, and the indispensable role of multidisciplinary team (MDT) management. Clinicians should maintain a high index of suspicion for ibrutinib as the culprit when patients on this therapy develop cardiovascular, haematological, infectious, or dermatological complications.
PMID:
42819318
Bibliographic data and abstract were imported from PubMed on 02 Oct 2026.
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