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Myocarditis associated with immune checkpoint inhibitor therapy: a case report of three patients.

Publication ,  Journal Article
Ansari-Gilani, K; Tirumani, SH; Smith, DA; Nelson, A; Alahmadi, A; Hoimes, CJ; Ramaiya, NH
Published in: Emerg Radiol
August 2020

Immune checkpoint inhibitor (ICI)-associated myocarditis is a rare but potentially fatal complication associated with development of other immune-related adverse events (irAEs). Troponin levels, ECG, echocardiography, and cardiac MR can assist with the diagnosis of this rare albeit serious adverse effect related to immunotherapy. In this case report, we present the clinical and radiological features of myocarditis in three patients presenting with acute symptoms while receiving therapy with ICIs. Blood troponin and ECG were abnormal in all three myocarditis cases. Initial echocardiography was abnormal in two patients with reduced left ventricular ejection fraction (LVEF). The third patient demonstrated an initially normal LVEF with subsequent transient decrease in LVEF on follow-up echocardiogram. Cardiac MR was abnormal in three cases with areas of mid-myocardial/epicardial delayed enhancement. All patients experienced additional irAEs. One patient died shortly after myocarditis diagnosis, one was made comfort care due to poor clinical status, and one improved with steroid treatment.

Duke Scholars

Published In

Emerg Radiol

DOI

EISSN

1438-1435

Publication Date

August 2020

Volume

27

Issue

4

Start / End Page

455 / 460

Location

United States

Related Subject Headings

  • Skin Neoplasms
  • Nuclear Medicine & Medical Imaging
  • Myocarditis
  • Melanoma
  • Male
  • Magnetic Resonance Imaging
  • Kidney Neoplasms
  • Immune Checkpoint Inhibitors
  • Humans
  • Female
 

Citation

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Ansari-Gilani, K., Tirumani, S. H., Smith, D. A., Nelson, A., Alahmadi, A., Hoimes, C. J., & Ramaiya, N. H. (2020). Myocarditis associated with immune checkpoint inhibitor therapy: a case report of three patients. Emerg Radiol, 27(4), 455–460. https://doi.org/10.1007/s10140-020-01765-6
Ansari-Gilani, Kianoush, Sree Harsha Tirumani, Daniel A. Smith, Ariel Nelson, Asrar Alahmadi, Christopher J. Hoimes, and Nikhil H. Ramaiya. “Myocarditis associated with immune checkpoint inhibitor therapy: a case report of three patients.Emerg Radiol 27, no. 4 (August 2020): 455–60. https://doi.org/10.1007/s10140-020-01765-6.
Ansari-Gilani K, Tirumani SH, Smith DA, Nelson A, Alahmadi A, Hoimes CJ, et al. Myocarditis associated with immune checkpoint inhibitor therapy: a case report of three patients. Emerg Radiol. 2020 Aug;27(4):455–60.
Ansari-Gilani, Kianoush, et al. “Myocarditis associated with immune checkpoint inhibitor therapy: a case report of three patients.Emerg Radiol, vol. 27, no. 4, Aug. 2020, pp. 455–60. Pubmed, doi:10.1007/s10140-020-01765-6.
Ansari-Gilani K, Tirumani SH, Smith DA, Nelson A, Alahmadi A, Hoimes CJ, Ramaiya NH. Myocarditis associated with immune checkpoint inhibitor therapy: a case report of three patients. Emerg Radiol. 2020 Aug;27(4):455–460.
Journal cover image

Published In

Emerg Radiol

DOI

EISSN

1438-1435

Publication Date

August 2020

Volume

27

Issue

4

Start / End Page

455 / 460

Location

United States

Related Subject Headings

  • Skin Neoplasms
  • Nuclear Medicine & Medical Imaging
  • Myocarditis
  • Melanoma
  • Male
  • Magnetic Resonance Imaging
  • Kidney Neoplasms
  • Immune Checkpoint Inhibitors
  • Humans
  • Female