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Alrayyashi M, Uddin M, Bdiwi M, Afonso L. Immune checkpoint inhibitor-induced myopericarditis. BMJ Case Rep 2024; 17:e259497. [PMID: 38514163 PMCID: PMC10961502 DOI: 10.1136/bcr-2023-259497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024] Open
Abstract
A woman in her 30s with a medical history of metastatic rectal adenocarcinoma, currently on pembrolizumab, which started a few weeks ago, was admitted for abdominal pain. During the hospital stay, she experienced sharp chest pain. Troponin was 1885 ng/mL which peaked at 7338 ng/mL. ECG was unremarkable. The echocardiogram showed an Ejection fraction (EF) of 55%-60% and basal-inferior wall hypokinesis. Left heart catheterisation showed no coronary abnormalities. Cardiac MRI showed a non-coronary area of focal T1 and T2 hyperintense signal and transmural delayed gadolinium enhancement in the mid-basal inferior/inferoseptal wall consistent with myocardial damage. Pericardium showed increased thickness and adhesions at the right ventricular outflow tract consistent with pericarditis. Steroid therapy was initiated, and a marked clinical response was achieved. Immune checkpoint inhibitor-induced myocarditis and pericarditis is a rare complication associated with a high mortality rate, if untreated. Diagnosis requires a multidisciplinary approach, and early detection is critical to preventing a fatal outcome.
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Affiliation(s)
- Mohamed Alrayyashi
- Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Mohammed Uddin
- Cardiology, Wayne State University, Warren, Michigan, USA
| | - Mustafa Bdiwi
- Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Luis Afonso
- Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
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Cau R, Solinas C, De Silva P, Lambertini M, Agostinetto E, Scartozzi M, Montisci R, Pontone G, Porcu M, Saba L. Role of cardiac MRI in the diagnosis of immune checkpoint inhibitor-associated myocarditis. Int J Cancer 2022; 151:1860-1873. [PMID: 35730658 DOI: 10.1002/ijc.34169] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 05/24/2022] [Accepted: 05/27/2022] [Indexed: 11/11/2022]
Abstract
Immune Checkpoint Inhibitor (ICI)-induced cardiotoxicity is a rare immune-related adverse event (irAE) characterized by a high mortality rate. From a pathological point of view, this condition can result from a series of causes, including binding of ICIs to target molecules on non-lymphocytic cells, cross-reaction of T lymphocytes against tumor antigens with off-target tissues, generation of autoantibodies, and production of pro-inflammatory cytokines. The diagnosis of ICI-induced cardiotoxicity can be challenging, and cardiac magnetic resonance (CMR) represents the diagnostic tool of choice in clinically stable patients with suspected myocarditis. CMR is gaining a central role in diagnosis and monitoring of cardiovascular damage in cancer patients, and it is entering international cardiology and oncology guidelines. In this narrative review, we summarized the clinical aspects of ICI-associated myocarditis, highlighting its radiological aspects and proposing a novel algorithm for the use of CMR.
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Affiliation(s)
- Riccardo Cau
- Department of Radiology, AOU Cagliari, University of Cagliari, Italy
| | - Cinzia Solinas
- Medical Oncology, S. Francesco Hospital, Azienda Tutela della Salute della Sardegna, Nuoro, Italy
| | - Pushpamali De Silva
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Matteo Lambertini
- Department of Medical Oncology, UOC Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Elisa Agostinetto
- Institut Jules Bordet and Université Libre de Bruxelles (U.L.B), Brussels, Belgium.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Mario Scartozzi
- Department of Medical Oncology, University of Cagliari, Cagliari, Italy
| | - Roberta Montisci
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | - Michele Porcu
- Department of Radiology, AOU Cagliari, University of Cagliari, Italy
| | - Luca Saba
- Department of Radiology, AOU Cagliari, University of Cagliari, Italy
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Liu Z, Fan Y, Guo J, Bian N, Chen D. Fulminant myocarditis caused by immune checkpoint inhibitor: a case report and possible treatment inspiration. ESC Heart Fail 2022; 9:2020-2026. [PMID: 35322589 PMCID: PMC9065848 DOI: 10.1002/ehf2.13912] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/17/2022] [Accepted: 03/09/2022] [Indexed: 12/19/2022] Open
Abstract
Immune checkpoint inhibitors (ICIs) have become a new hope for many patients with advanced cancer by blocking tumour immune evasion. However, with the widespread use of ICIs, immune-related adverse events (irAEs) have also been discovered and reported increasingly. Immune-related myocarditis, the most dangerous one of irAEs, still has high mortality in the context of the current treatment. We report the case of a 60-year-old female with fulminant myocarditis induced by ICIs, which caused her to experience frequent ventricular arrhythmias such as ventricular fibrillation and heart failure. She was successfully treated with current mainstream therapies for immune-related myocarditis and additional treatment of sacubitril-valsartan and dapagliflozin. The intriguing observation that the patient condition recovered relatively rapidly in this case shows a possible treatment inspiration, which may be helpful for treating ICIs-associated myocarditis and improving cancer patients' clinical prognosis.
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Affiliation(s)
- Zhijie Liu
- Department of CardiologyThe First Affiliated Hospital of Jinan UniversityGuangzhou510630China
| | - Yiming Fan
- Department of CardiologyThe First Affiliated Hospital of Jinan UniversityGuangzhou510630China
| | - Jun Guo
- Department of CardiologyThe First Affiliated Hospital of Jinan UniversityGuangzhou510630China
| | - Ning Bian
- Department of CardiologyThe First Affiliated Hospital of Jinan UniversityGuangzhou510630China
| | - Dongdong Chen
- Department of CardiologyThe First Affiliated Hospital of Jinan UniversityGuangzhou510630China
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