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Patients with human immunodeficiency virus (HIV) have 1,000 times the risk of developing pulmonary artery (PA) hypertension (PAH) as non-HIV-infected individuals, but PA pressures (PAPs) rarely reach systemic levels. At the same time, PAH associated with methamphetamine use is associated with a grave prognosis and higher mortality than idiopathic PAH (IPAH). This case report demonstrates the particularly pernicious and synergistic effect of HIV infection and long-term recreational methamphetamine use in the development of very severe PAH and cor pulmonale. Multimodality imaging and hemodynamic studies in our patient revealed PAPs and cardiac remodeling well beyond what is typically seen in non–methamphetamine users with HIV-associated PAH.

Cor Pulmonale from Concomitant Human Immunodeficiency Virus Infection and Methamphetamine Use