Life-threatening Autoimmune Cardiomyopathy Reproducibly Induced in a Patient by Checkpoint Inhibitor Therapy

Tajmir-Riahi A, Bergmann T, Schmid M, Agaimy A, Schuler G, Heinzerling L (2018)

Publication Type: Journal article

Publication year: 2018

Journal

Journal of Immunotherapy Lippincott, Williams & Wilkins

Book Volume: 41

Pages Range: 35-38

Journal Issue: 1

DOI: 10.1097/CJI.0000000000000190

Abstract

Checkpoint inhibitors induce a plethora of immune-related adverse events (irAEs) including autoimmune colitis, hepatitis, endocrinopathies, and rarer side effects like neuritis. Here, a case of autoimmune cardiomyopathy (grade 3 CTCAE) and myocarditis under combination therapy with nivolumab plus ipilimumab in a 72-year-old melanoma patient is reported. Treatment induced a partial response for 14 months. However, after 10 infusions the patient developed dyspnea, edema of the legs, ascites and a weight gain of 10 kg because of a decompensated heart insufficiency with a reduced ejection fraction from formerly 48%-50% to 15%. Ischemia and viral infections were ruled out. Histopathology showed hypertrophic myocarditis with interstitial lymphocytes. Prednisolone improved the patient's condition within 3 days, leading to a 25% and 30% ejection fraction after 2 and 8 weeks, respectively, and clinical symptoms subsided completely. Importantly, reinduction of anti-PD1 therapy resulted in a flare of myocarditis. Awareness for potentially life-threatening irAE of checkpoint inhibitors like autoimmune cardiomyopathy and myocarditis is crucial to rapidly initiate adequate treatment.

Authors with CRIS profile

Azadeh Tajmir-Riahi Department of Dermatology Abbas Agaimy Lehrstuhl für Allgemeine Pathologie und Pathologische Anatomie Gerold Schuler Lehrstuhl für Haut- und Geschlechtskrankheiten Lucie Heinzerling Department of Dermatology

Involved external institutions

Universitätsklinikum Regensburg DE Germany (DE)

How to cite

APA:

Tajmir-Riahi, A., Bergmann, T., Schmid, M., Agaimy, A., Schuler, G., & Heinzerling, L. (2018). Life-threatening Autoimmune Cardiomyopathy Reproducibly Induced in a Patient by Checkpoint Inhibitor Therapy. Journal of Immunotherapy, 41(1), 35-38. https://dx.doi.org/10.1097/CJI.0000000000000190

MLA:

Tajmir-Riahi, Azadeh, et al. "Life-threatening Autoimmune Cardiomyopathy Reproducibly Induced in a Patient by Checkpoint Inhibitor Therapy." Journal of Immunotherapy 41.1 (2018): 35-38.

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