Myocarditis Following Immune Checkpoint Inhibition With Pembrolizumab: Management in a Context of Steroid Intolerance

Authors

Laura L. Onderko, Department of Cardiology, Maine Medical Center, Portland, Maine, USA.
Ross Heinrich, Department of Internal Medicine, Maine Medical Center, Portland, Maine, USA.
Katalin Gosling, Department of Cardiology, Maine Medical Center, Portland, Maine, USA.
Tim Downs, Department of Cardiology, Maine Medical Center, Portland, Maine, USA.
Maxwell Eyram Afari, Department of Cardiology, Maine Medical Center, Portland, Maine, USA.

Document Type

Article

Publication Date

7-2022

Institution/Department

Cardiology

Journal Title

CJC open

Abstract

Immune checkpoint inhibitors (ICIs) are a major advance in oncology and have become first- or second-line therapy for over 50% of oncology patients. ICI-associated myocarditis is a complication that, although rare, has a high mortality rate. We present a case of ICI-associated myocarditis presenting as complete heart block. Traditional treatment with high-dose steroids was abandoned in this case, owing to steroid-induced psychosis. Alternative treatment with immunomodulators was initiated with a good response. This case highlights the variable presentation of ICI-associated myocarditis. As use of ICIs continues to expand, an understanding of their adverse reactions and best treatments will be needed.

Comments

Laura Onderko, MD- Fellow

Ross Heinrich- Resident

First Page

854

Last Page

857

Recommended Citation

Onderko LL, Heinrich R, Gosling K, Downs T, Afari ME. Myocarditis Following Immune Checkpoint Inhibition With Pembrolizumab: Management in a Context of Steroid Intolerance. CJC Open. 2022;4(10):854-857. Published 2022 Jul 11. doi:10.1016/j.cjco.2022.07.002