迟发性ici相关心肌炎

Q4 Medicine

JACC. Case reports Pub Date : 2025-10-01 DOI:10.1016/j.jaccas.2025.105307

Fadi W. Adel MD, Ghasaq Saleh MD, Nandan S. Anavekar MBBCh, Sharonne N. Hayes MD

{"title":"迟发性ici相关心肌炎","authors":"Fadi W. Adel MD, Ghasaq Saleh MD, Nandan S. Anavekar MBBCh, Sharonne N. Hayes MD","doi":"10.1016/j.jaccas.2025.105307","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Immune checkpoint inhibitors (ICIs) are increasingly used in cancer therapy, but they may cause immune-related adverse events, including myocarditis, a rare but potentially fatal complication.</div></div><div><h3>Case Summary</h3><div>A 74-year-old man with lung adenocarcinoma treated with durvalumab presented with acute-on-chronic hypoxemic respiratory failure and hypotension. He was recently diagnosed with ICI pneumonitis and was taking corticosteroids. Evaluation revealed elevated troponins, new T-wave inversions, and reduced left ventricular ejection fraction. Coronary angiography showed no obstructive disease. Cardiac magnetic resonance revealed diffuse myocardial edema with nonischemic late gadolinium enhancement. Endomyocardial biopsy confirmed lymphohistiocytic infiltrates consistent with ICI myocarditis.</div></div><div><h3>Discussion</h3><div>ICI-associated myocarditis can mimic acute coronary syndrome or stress cardiomyopathy. Cardiac magnetic resonance and biopsy are essential for accurate diagnosis. Early recognition and initiation of high-dose corticosteroids are critical for improved outcomes.</div></div><div><h3>Take-Home Messages</h3><div>ICI myocarditis should be considered in patients with prior ICI exposure and new cardiomyopathy. Multimodal imaging and biopsy are key to timely diagnosis and management.</div></div>","PeriodicalId":14792,"journal":{"name":"JACC. Case reports","volume":"30 30","pages":"Article 105307"},"PeriodicalIF":0.0000,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Delayed-Onset ICI-Associated Myocarditis\",\"authors\":\"Fadi W. Adel MD, Ghasaq Saleh MD, Nandan S. Anavekar MBBCh, Sharonne N. Hayes MD\",\"doi\":\"10.1016/j.jaccas.2025.105307\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Immune checkpoint inhibitors (ICIs) are increasingly used in cancer therapy, but they may cause immune-related adverse events, including myocarditis, a rare but potentially fatal complication.</div></div><div><h3>Case Summary</h3><div>A 74-year-old man with lung adenocarcinoma treated with durvalumab presented with acute-on-chronic hypoxemic respiratory failure and hypotension. He was recently diagnosed with ICI pneumonitis and was taking corticosteroids. Evaluation revealed elevated troponins, new T-wave inversions, and reduced left ventricular ejection fraction. Coronary angiography showed no obstructive disease. Cardiac magnetic resonance revealed diffuse myocardial edema with nonischemic late gadolinium enhancement. Endomyocardial biopsy confirmed lymphohistiocytic infiltrates consistent with ICI myocarditis.</div></div><div><h3>Discussion</h3><div>ICI-associated myocarditis can mimic acute coronary syndrome or stress cardiomyopathy. Cardiac magnetic resonance and biopsy are essential for accurate diagnosis. Early recognition and initiation of high-dose corticosteroids are critical for improved outcomes.</div></div><div><h3>Take-Home Messages</h3><div>ICI myocarditis should be considered in patients with prior ICI exposure and new cardiomyopathy. Multimodal imaging and biopsy are key to timely diagnosis and management.</div></div>\",\"PeriodicalId\":14792,\"journal\":{\"name\":\"JACC. Case reports\",\"volume\":\"30 30\",\"pages\":\"Article 105307\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JACC. Case reports\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2666084925020881\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"JACC. Case reports","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2666084925020881","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}

引用次数: 0

摘要

免疫检查点抑制剂（ici）越来越多地用于癌症治疗，但它们可能引起免疫相关的不良事件，包括心肌炎，这是一种罕见但潜在致命的并发症。病例总结：一名74岁男性肺腺癌患者接受durvalumab治疗后出现急性慢性低氧性呼吸衰竭和低血压。他最近被诊断为ICI肺炎，正在服用皮质类固醇。评估显示肌钙蛋白升高，新的t波倒置，左心室射血分数降低。冠状动脉造影未见阻塞性疾病。心脏磁共振显示弥漫性心肌水肿伴非缺血性晚期钆增强。心肌内膜活检证实淋巴组织细胞浸润符合ICI心肌炎。ci相关性心肌炎可模拟急性冠状动脉综合征或应激性心肌病。心脏磁共振和活检是准确诊断的必要条件。早期识别和开始使用大剂量皮质类固醇对改善预后至关重要。有ICI暴露史和新发心肌病的患者应考虑ICI心肌炎。多模式成像和活检是及时诊断和治疗的关键。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Delayed-Onset ICI-Associated Myocarditis

Background

Immune checkpoint inhibitors (ICIs) are increasingly used in cancer therapy, but they may cause immune-related adverse events, including myocarditis, a rare but potentially fatal complication.

Case Summary

A 74-year-old man with lung adenocarcinoma treated with durvalumab presented with acute-on-chronic hypoxemic respiratory failure and hypotension. He was recently diagnosed with ICI pneumonitis and was taking corticosteroids. Evaluation revealed elevated troponins, new T-wave inversions, and reduced left ventricular ejection fraction. Coronary angiography showed no obstructive disease. Cardiac magnetic resonance revealed diffuse myocardial edema with nonischemic late gadolinium enhancement. Endomyocardial biopsy confirmed lymphohistiocytic infiltrates consistent with ICI myocarditis.

Discussion

ICI-associated myocarditis can mimic acute coronary syndrome or stress cardiomyopathy. Cardiac magnetic resonance and biopsy are essential for accurate diagnosis. Early recognition and initiation of high-dose corticosteroids are critical for improved outcomes.

Take-Home Messages

ICI myocarditis should be considered in patients with prior ICI exposure and new cardiomyopathy. Multimodal imaging and biopsy are key to timely diagnosis and management.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊