Asymptomatic Immune Checkpoint Inhibitor-associated Myocarditis
Junya Tanabe1, Nobuhide Watanabe1, Akihiro Endo1
1Division of Cardiology, Shimane University Faculty of Medicine, Japan.
Internal Medicine (Tokyo, Japan)
|October 8, 2020
Summary
This case study highlights immune checkpoint inhibitor (ICI)-associated myocarditis in a 75-year-old man. Careful prednisolone (PSL) management prevented myasthenia gravis (MG) exacerbation while treating myocarditis.
Area of Science:
- Cardiology
- Immunology
- Neurology
Background:
- Immune checkpoint inhibitors (ICIs) can cause myocarditis, a serious cardiac condition.
- Myasthenia gravis (MG) is a potential complication of ICI therapy.
- Managing co-occurring conditions requires careful therapeutic strategies.
Observation:
- A 75-year-old male presented with asymptomatic myocarditis, indicated by elevated cardiac biomarkers (creatine kinase, CK-myocardial band, troponin I).
- The patient also had suspected myasthenia gravis (MG).
Findings:
- Gradual escalation of prednisolone (PSL) from 5 mg/day to 20 mg/day normalized troponin I levels.
- This cautious PSL dosing strategy avoided exacerbation of MG and associated side effects.
- The case demonstrates successful management of ICI-associated myocarditis in a patient with co-occurring MG.
Implications:
- This case underscores the importance of considering myasthenia gravis (MG) when managing immune checkpoint inhibitor (ICI)-associated myocarditis.
- Careful, dose-adjusted immunosuppressive therapy, such as with prednisolone (PSL), can be effective in treating myocarditis while mitigating risks for MG patients.
- Clinicians must carefully weigh the risks and benefits of immunosuppressive treatments in patients with complex immune-related adverse events.
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