Tajmir-Riahi, Azadeh and Bergmann, Tanja and Schmid, Michael and Agaimy, Abbas and Schuler, Gerold and Heinzerling, Lucie (2018) Life-threatening Autoimmune Cardiomyopathy Reproducibly Induced in a Patient by Checkpoint Inhibitor Therapy. JOURNAL OF IMMUNOTHERAPY, 41 (1). pp. 35-38. ISSN 1524-9557, 1537-4513
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Checkpoint inhibitors induce a plethora of immune-related adverse events (irAEs) including autoimmune colitis, hepatitis, endocrinopathies, and rarer side effects like neuritis. Here, a case of autoimmune cardiomyopathy (grade 3 CTCAE) and myocarditis under combination therapy with nivolumab plus ipilimumab in a 72-year-old melanoma patient is reported. Treatment induced a partial response for 14 months. However, after 10 infusions the patient developed dyspnea, edema of the legs, ascites and a weight gain of 10kg because of a decompensated heart insufficiency with a reduced ejection fraction from formerly 48%-50% to 15%. Ischemia and viral infections were ruled out. Histopathology showed hypertrophic myocarditis with interstitial lymphocytes. Prednisolone improved the patient's condition within 3 days, leading to a 25% and 30% ejection fraction after 2 and 8 weeks, respectively, and clinical symptoms subsided completely. Importantly, reinduction of anti-PD1 therapy resulted in a flare of myocarditis. Awareness for potentially life-threatening irAE of checkpoint inhibitors like autoimmune cardiomyopathy and myocarditis is crucial to rapidly initiate adequate treatment.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | MYOCARDITIS; IPILIMUMAB; PEMBROLIZUMAB; melanoma; CTLA-4; PD-1; programmed cell death protein 1; immune-related cardiomyopathy and myocarditis; immune-related adverse events |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Innere Medizin I |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 20 Mar 2020 07:44 |
| Last Modified: | 20 Mar 2020 07:44 |
| URI: | https://pred.uni-regensburg.de/id/eprint/15275 |
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