Accelerated Systemic Atherosclerosis Following Immune-Related Adverse Events in a Patient with Primary Thoracic Melanoma: A Case of Sequential Coronary and Peripheral Revascularization.

Abstract

Immune checkpoint inhibitors (ICIs) improve survival in advanced melanoma, but they may accelerate atherosclerosis, particularly in patients with immune-related adverse events (irAEs). A 64-year-old man with stage IV BRAF-wild-type primary thoracic melanoma achieved complete remission after nivolumab plus ipilimumab, but he later developed grade 3 immune-related hepatitis, requiring treatment discontinuation. Three and a half years later, symptomatic peripheral artery disease required revascularization, followed by severe coronary artery disease requiring percutaneous coronary intervention one year later. This case suggests that severe irAEs may be associated with accelerated systemic atherosclerosis, highlighting the importance of long-term cardiovascular surveillance following ICI therapy.