Abstract
Patient was a 58 years old woman with metastatic non-small cell lung adenocarcinoma received palliative radiation therapy and chemotherapy with cisplatin and etoposide. Chemotherapy then switched to nivolumab.
She presented with an episode of unwitnessed syncope. ECG showed normal sinus rhythm and new bi-fascicular block. There was no orthostatic hypotension.
Lab work revealed elevated troponin. We were suspicious to immune checkpoint inhibitor myocarditis and Nivolumab was put on hold. Coronary angiogram was done, and coronary arteries were normal.
Echocardiogram revealed normal left ventricular size and wall thickness. LV ejection fraction was estimated at 50%. CMR confirmed diagnosis of myocarditis.
Patient was promptly started on high dose intravenous methylprednisolone (1000 mg/day for 3 days), with progressive tapering. The patient’s troponin levels trended down quickly.
The ejection fraction improved and on follow up patient is doing well from cardiovascular standpoint, however, was not started back on Nivolumab.
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Rohani, A. (2021). Immune Checkpoint Inhibitor Cardiovascular Toxicities. In: Clinical Cases in Cardio-Oncology. Clinical Cases in Cardiology. Springer, Cham. https://doi.org/10.1007/978-3-030-71155-9_10
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DOI: https://doi.org/10.1007/978-3-030-71155-9_10
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