Oncol Case Rep J | Volume 5, Issue 1 | Case Report | Open Access

Fulminant Myocarditis Secondary to Nivolumab and Ipilimumab Dual Checkpoint-Inhibitor Therapy: A Case Report on Immune Checkpoint Inhibitor Cardiotoxicity

Kevin Liu1*, Chagai Mendelson2, John J Liang3, Monika Gautam4, Hayder D Hashim2, Ana Barac2,5 and Alexander I Papolos2,6

1Department of Internal Medicine, MedStar Georgetown University Hospital, USA
2Department of Medicine, Division of Cardiology, MedStar Heart and Vascular Institute, Washington Hospital
Center, USA
3Division of Pathology, MedStar Washington Hospital Center, USA
4Department of Internal Medicine, MedStar Georgetown/Washington Hospital Center, USA
5Georgetown University, Washington, DC, USA
6Department of Critical Care, MedStar Washington Hospital Center, USA

*Correspondance to: Kevin Liu 

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Abstract

This case report identifies patients undergoing treatment with immune checkpoint inhibitors as
a growing population at risk of developing myocardial injury ranging the spectrum from mild
myocarditis/pericarditis-type symptoms to, in this case, fulminant myocarditis with cardiogenic
shock. We herein also call for both a standard approach for treatment and identification of immunecheckpoint
inhibitor myocarditis, as well as highlight some novel therapeutic options that have
recently been described and are ongoing in clinical trials.
Herein we describe an 80-year-old woman history of atrial fibrillation, hypertension, hyperlipidemia,
and newly diagnosed metastatic renal cell carcinoma treated with nivolumab and ipilimumab who
presents with acute onset of diarrhea, anorexia, and dyspnea found to be in isolated right ventricular
cardiogenic shock given non-obstructive coronary disease. Interventions and diagnostics included
prompt initiation of high-dose methylprednisolone, a left heart catheterization and angiography,
right heart catheterization with endomyocardial biopsy, and multimodal imaging including CT
scans and transthoracic echocardiograms.
The main take-away lessons from this case are to consider immune-checkpoint inhibitor therapy
in a patient presenting with overt or frank signs of cardiopulmonary overload, to always rule out
ischemic etiologies of typical angina and acute heart failure symptoms, and to highlight standard
and novel therapies for immune-checkpoint inhibitor-related cardiotoxicity.

Keywords:

Case report; Checkpoint-Inhibitor; Myocarditis; Nivolumab; Ipilimumab; Renal cell carcinoma immunotherapy

Citation:

Liu K, Mendelson C, Liang JJ, Gautam M, Hashim HD, Barac A, et al. Fulminant Myocarditis Secondary to Nivolumab and Ipilimumab Dual Checkpoint-Inhibitor Therapy: A Case Report on Immune Checkpoint Inhibitor Cardiotoxicity. Oncol Case Report J. 2022; 5(1): 1046. ISSN: 2641-9173.

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