A severe cardiac complication of immune checkpoint inhibitor therapy

Abstract

The use of immune checkpoint inhibitors (ICIs) is progressively broadening within oncology therapy. In parallel, as cardiologists, we anticipate an increasing incidence of cardiovascular immune-mediated complications, including myocarditis and pericarditis. These complications, without early and appropriate treatment can lead to fatal outcomes. Therefore, patient education, preceding cardiovascular screening, comprehensive assessment and therapeutic intervention upon symptomatic manifestation, is of paramount importance. In our case, we discuss a late-onset cardiovascular complication in a patient receiving ICI therapy with pembrolizumab for lung adenocarcinoma. Following the completion of treatment, the patient developed perimyocarditis, which was confirmed by cardiac MRI. Clinical improvement was observed with high-dose corticosteroid treatment; however, later on, signs of pericardial constriction were detected on echocardiography, which was confirmed by cardiac catheterization. For this reason, the patient underwent surgical pericardiectomy, with a good effect.

Keywords

• immune checkpoint inhibitor therapy
• perimyocarditis
• pericardial constriction