Pericardial, Pleural Effusion and Anasarca: A Rare Complication of Low-Dose Oral Minoxidil for Hair Loss

A 40-year-old, healthy, Black, South African woman with frontal fibrosing alopecia (FFA) developed pericardial, pleural effusion, and anasarca 3 weeks after starting low-dose oral minoxidil (LDOM) therapy. The patient was treated with 5% topical minoxidil, tacrolimus ointment 0.1%, clobetasol propionate ointment, 100 mg of doxycycline twice daily, and 0.25 mg of oral minoxidil daily. After 3 weeks of treatment, the patient noticed swelling in her extremities and face. She was admitted to the hospital for further management. Her laboratory workup was unremarkable, showing normal renal, hepatic, and thyroid function, and normal levels of inflammatory markers. Ultrasound showed fluid collections in the pericardium, pleural space, and abdomen. The patient was treated with 40 mg of intravenous furosemide daily for 4 days, and the edema was alleviated. After cessation of LDOM, the diuretics were discontinued, without any further recurrence of edema. At follow-up 2 weeks later, complete resolution was observed both clinically and using ultrasound. The researchers concluded that LDOM was responsible for her clinical presentation.