Fulminant Myocarditis Caused by an Immune Checkpoint Inhibitor: A Case Report With Pathologic Findings

Imai, Ryosuke; Ono, Masafumi; Nishimura, Naoki; Suzuki, Koyu; Komiyama, Nobuyuki; Tamura, Tomohide

doi:10.1016/j.jtho.2018.10.156

Cited by 23 publications

(28 citation statements)

References 3 publications

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“…Cardiovascular toxicities are among the rare organ toxicities of ICI therapy [5, 6]. With increased use of ICIs over the past few years, numerous reports of cardiovascular toxicities have emerged (summarized in Table 1, Table 2, Table 3) [7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35]. The most serious among them is the development of fulminant myocarditis, a potentially fatal clinical disease which has been the primary focus for the cardio-oncology community [12].…”

Section: Introductionmentioning

confidence: 99%

Cardiac Toxicity Associated with Immune Checkpoint Inhibitors: Case Series and Review of the Literature

Agrawal¹,

et al. 2019

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The development of immune checkpoint inhibitors (ICIs) has revolutionized the treatment of patients with advanced stage cancers. However, immune-related adverse events are frequently observed. Cardiac toxicity from ICI therapy can range from asymptomatic troponin-I elevations to conduction abnormalities of the heart and even fulminant myocarditis. Although rare, myocarditis is a potentially fatal adverse effect of ICI therapy. We present a series of five cases of ICI-related cardio-toxicity diagnosed and managed at Roswell Park Comprehensive Cancer Center along with a review of published case reports in the literature. Our series highlights the importance of high clinical suspicion, early diagnosis of myocarditis, and prompt initiation of immunosuppressive therapy.

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Section: Introductionmentioning

confidence: 99%

Cardiac Toxicity Associated with Immune Checkpoint Inhibitors: Case Series and Review of the Literature

Agrawal¹,

et al. 2019

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“…Corticosteroid therapy is a double-edged sword which may induce new allergic reactions while treating other immune reactions (43,44). Previous case reports have shown high levels of myocardial biomarkers such as N terminal pro-hormone B-type natriuretic peptide (NT-proBNP), high sensitivity (hs)-troponin, and creatine kinase (CK) (10,18,20). In contrast, our lung cancer patient did not present with drastically altered levels of these biomarkers.…”

Section: Discussionmentioning

confidence: 56%

“…However, it is rarely performed due to its invasive nature and risk of complications such as major perforation (36). Among the 20 cases reviewed, only four patients received an endomyocardial biopsy test, of which one was a diagnostic autopsy (9,14,20,23). The pathological sections showed scattered inflammatory lesions, necrosis of cardiomyocytes and granulated tissue, and infiltrating T cells and macrophages.…”

Section: Discussionmentioning

confidence: 99%

“…In this investigation, the clinical characteristics, diagnosis, and treatment of 20 cases of ICI-induced myocarditis in patients with lung cancer were reviewed and summarized in Table 1 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). We present the following article in accordance with the CARE reporting checklist (available at http://dx.doi.org/10.21037/apm-20-2449).…”

Section: Introductionmentioning

confidence: 99%

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Immune checkpoint inhibitor-induced myocarditis in lung cancer patients: a case report of sintilimab-induced myocarditis and a review of the literature

Bi¹,

Wang²,

Ding³

et al. 2021

Ann Palliat Med

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Since its initial approval by the United States Food and Drug Administration (FDA) in 2014, the indications for the use of the immune checkpoint inhibitors (ICIs) in non-small cell lung cancer (NSCLC) patients has increased. However, to date, there has no report on immune myocarditis caused by the ICI sintilimab. In addition, there has been no literature review on ICI-induced myocarditis in lung cancer patients. This is a case report of an elderly male patient who presented with a productive cough and progressive dysphagia for 3 days. The symptoms started on day 6 after the third cycle of sintilimab treatment for his lung carcinoma. In accordance with his clinical manifestations of progressive dysphagia, a previous history of lung cancer, abnormal electrocardiograph, significantly increased serum myocardial enzyme levels, and normal coronary angiography results, sintilimab-induced myocarditis was diagnosed.Methylprednisolone (80-40 mg) was used to inhibit the immune injury and the patient was safely discharged on the 13th day following admission. Since ICI-induced myocarditis is rare and fatal, we summarized the characteristics of 20 cases of the disease in lung cancer patients to highlight to oncologists, respiratory experts, and cardiologists the serious side effects of the drug when they encounter lung cancer patients using ICIs. Like most ICIs, sintilimab induces severe immune myocarditis and requires corticosteroids therapy, and this should be recognized by doctors in multiple departments.

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“…Management of patients with ICI-associated myocarditis has so far been reported to include high-dose glucocorticoids in the majority of patients, with other immunosuppressants such as infliximab or IVIG in used in some steroidrefractory patients, and case reports with the successful use of ATG in patients with fulminant disease (7,13,14,(27)(28)(29)(30). In general, ICI therapy is discontinued in patients diagnosed with ICI-associated myocarditis, as this is categorized as a high-grade irAE (4,31).…”

Section: Presentation and Diagnosis Of Ici-associated Myocarditismentioning

confidence: 99%

Clinical and Advanced MRI Techniques for Detection of Checkpoint Inhibitor Associated Myocarditis

Arbune

Soufer

Baldassarre

2020

Curr Cardiovasc Imaging Rep

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Purpose of Review With the advent of immune checkpoint inhibitors (ICIs), cancer treatment has been revolutionized; however, these agents are associated with immune-related adverse events, including myocarditis, which ranges from mild to fulminant in severity. Currently, there are no established guidelines in diagnosing ICI-associated myocarditis, and the gold standard test for diagnosis of myocarditis in general is invasive endomyocardial biopsy (EMB). Cardiac magnetic resonance (CMR) imaging is a noninvasive test with the advantage of providing structural, functional and tissue characterization information. Additionally, it provides high spatial and temporal resolution without exposure to ionizing radiation, iodinated contrast, or radioactive isotopes. Recent Findings With an increasing number of reported cases of ICI associated myocarditis, understanding of the disease process and associated CMR findings is growing. Diagnostic testing with cardiac biomarkers, electrocardiogram, and echocardiogram can be nonspecific and EMB can have sampling errors. CMR as a diagnostic tool can provide functional assessment of biventricular ejection fraction, myocardial strain, tissue characterization of myocardial edema and inflammation as well as fibrosis. Furthermore, with advanced parametric mapping techniques, CMR provides even more sensitive and quantitative information about myocardial inflammation and fibrosis, including measurements of extracellular volume. Summary ICI-associated myocarditis is a serious immune adverse event, and CMR plays a vital role in establishing its diagnosis, providing prognostic information, and has the potential for use as a tool for screening and serial monitoring in patients exposed to ICIs.

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Fulminant Myocarditis Caused by an Immune Checkpoint Inhibitor: A Case Report With Pathologic Findings

Cited by 23 publications

References 3 publications

Cardiac Toxicity Associated with Immune Checkpoint Inhibitors: Case Series and Review of the Literature

Cardiac Toxicity Associated with Immune Checkpoint Inhibitors: Case Series and Review of the Literature

Immune checkpoint inhibitor-induced myocarditis in lung cancer patients: a case report of sintilimab-induced myocarditis and a review of the literature

Clinical and Advanced MRI Techniques for Detection of Checkpoint Inhibitor Associated Myocarditis

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