T-cell Therapy-Mediated Myocarditis Secondary to Cytokine Release Syndrome

Chimeric antigen receptor (CAR) T-cell therapy is expanding to a wider patient population; however, cytokine release syndrome (CRS) is the most important adverse event of these therapies. Patients suffering from high-grade CRS also develop signs of cardiac dysfunction and frequently manifest vascular leakage with peripheral and pulmonary edema. We present an unusual case of a 68-year-old female with stage III endometrial carcinosarcoma, who was admitted for T-cell therapy. The patient developed symptoms of CRS within 12 hours of T-cell therapy and expired shortly thereafter. Autopsy of the patient revealed interstitial edema and lymphocytic infiltrates in right and left ventricles along with foci of myocyte necrosis and perivascular fibrosis, more prominent in the right ventricle, consistent with immune therapy-mediated myocarditis. It is important to recognize that CRS progresses rapidly and can have potentially dangerous consequences, so it is imperative to anticipate and treat it early. Cases should be individualized and treated accordingly.