{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T05:20:16Z","timestamp":1770960016393,"version":"3.50.1"},"reference-count":13,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,12,17]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>Anthracycline-based chemotherapy is widely used in breast cancer but carries a risk of cardiotoxicity. Leptomeningeal carcinomatosis (LC) is a rare but fatal complication of metastatic breast cancer, often presenting with diverse neurological symptoms and requiring high clinical suspicion for diagnosis. We report a woman in her early 50s with HER2-positive breast cancer who received anthracycline-based chemotherapy. After treatment, she developed refractory ventricular tachycardia and underwent implantable cardioverter-defibrillator (ICD) implantation despite preserved cardiac function. Soon after, neurological symptoms appeared, and LC was diagnosed by cerebrospinal fluid cytology without supportive imaging. Her clinical course was rapidly progressive, and she died within days of diagnosis. This case underscores challenges in cardio-oncology, particularly the appropriateness of ICD implantation in advanced cancer with limited prognosis. It highlights the importance of continuous cardiac monitoring during and after anthracycline therapy and awareness of LC, especially when neurological or autonomic symptoms emerge.<\/jats:p>","DOI":"10.1136\/bcr-2025-269679","type":"journal-article","created":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T17:35:22Z","timestamp":1767720922000},"page":"e269679","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Decision-making challenges for implantable cardioverter-defibrillator therapy in breast cancer with ventricular tachycardia and undiagnosed leptomeningeal carcinomatosis"],"prefix":"10.1136","volume":"19","author":[{"given":"Yuto","family":"Watanabe","sequence":"first","affiliation":[{"name":"Department of Cardiology, Heart and Vascular Institute, Funabashi Municipal Medical Center, Funabashi, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9944-3762","authenticated-orcid":false,"given":"Rie","family":"Aoyama","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Heart and Vascular Institute, Funabashi Municipal Medical Center, Funabashi, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takashi","family":"Uchiyama","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Heart and Vascular Institute, Funabashi Municipal Medical Center, Funabashi, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shinichi","family":"Okino","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Heart and Vascular Institute, Funabashi Municipal Medical Center, Funabashi, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,1,6]]},"reference":[{"key":"2026010609351782000_19.1.e269679.1","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.1920"},{"key":"2026010609351782000_19.1.e269679.2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehac244"},{"key":"2026010609351782000_19.1.e269679.3","doi-asserted-by":"publisher","DOI":"10.1007\/s12574-020-00502-9"},{"key":"2026010609351782000_19.1.e269679.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.critrevonc.2019.01.020"},{"key":"2026010609351782000_19.1.e269679.5","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1159\/000455115","article-title":"Prognostic Markers and Histologic Subtypes in Patients with Meningeal Carcinomatosis in Breast Cancer","volume":"61","author":"Alnajar","year":"2017","journal-title":"Acta Cytol"},{"key":"2026010609351782000_19.1.e269679.6","doi-asserted-by":"crossref","DOI":"10.1016\/j.jaccas.2024.102532","article-title":"An Unusual Case of Anthracycline-Induced Ventricular Tachycardia in Pregnancy","volume":"29","author":"Lew","year":"2024","journal-title":"JACC Case Rep"},{"key":"2026010609351782000_19.1.e269679.7","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.jjcc.2023.11.001","article-title":"Effect of increase in heart rate after anthracycline chemotherapy on subsequent left ventricular dysfunction","volume":"84","author":"Kintsu","year":"2024","journal-title":"J Cardiol"},{"key":"2026010609351782000_19.1.e269679.8","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3181dc1a69"},{"key":"2026010609351782000_19.1.e269679.9","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1007\/s11060-021-03924-2","article-title":"Leptomeningeal metastases: the future is now","volume":"156","author":"Lukas","year":"2022","journal-title":"J Neurooncol"},{"key":"2026010609351782000_19.1.e269679.10","doi-asserted-by":"publisher","DOI":"10.1038\/s41416-020-01175-y"},{"key":"2026010609351782000_19.1.e269679.11","doi-asserted-by":"crossref","DOI":"10.3390\/cancers13122927","article-title":"Brain Metastases in HER2-Positive Breast Cancer: Current and Novel Treatment Strategies","volume":"13","author":"Garcia-Alvarez","year":"2021","journal-title":"Cancers (Basel)"},{"key":"2026010609351782000_19.1.e269679.12","doi-asserted-by":"crossref","DOI":"10.1177\/1758835920936117","article-title":"Evolving treatment strategies of brain metastases from breast cancer: current status and future direction","volume":"12","author":"Kim","year":"2020","journal-title":"Ther Adv Med Oncol"},{"key":"2026010609351782000_19.1.e269679.13","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jaccao.2021.01.011","article-title":"BSE and BCOS Guideline for Transthoracic Echocardiographic Assessment of Adult Cancer Patients Receiving Anthracyclines and\/or Trastuzumab","volume":"3","author":"Dobson","year":"2021","journal-title":"JACC CardioOncol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-269679","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T17:35:24Z","timestamp":1767720924000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-269679"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":13,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,6]]},"published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1136\/bcr-2025-269679"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-269679","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]}}}