Checkpoint Immunotherapy-Induced Myocarditis and Encephalitis Complicated With Complete AV Block: Not All Hope Is...

Area of Science:

• Immunology
• Cardiology
• Neurology

Background:

• Immune checkpoint inhibitors (ICIs) are crucial in cancer therapy.
• Adverse events, including autoimmune conditions, are known side effects of ICIs.
• Nivolumab and ipilimumab are commonly used ICIs.

Observation:

• A 70-year-old patient with renal-cell carcinoma developed myocarditis and encephalitis during nivolumab/ipilimumab treatment.
• The patient experienced progressive His-Purkinje system impairment, leading to complete atrioventricular block.
• These autoimmune complications affected cardiac conduction and brain function.

Findings:

• The patient's His-Purkinje system was gradually impaired, resulting in complete atrioventricular block.
• Myocarditis and encephalitis were diagnosed as autoimmune adverse events.
• Treatment with corticosteroids and immunoglobulins led to full recovery.

Implications:

• This case highlights the potential for severe cardiac and neurological autoimmune toxicity from ICIs.
• Early recognition and aggressive immunosuppressive therapy are vital for managing ICI-induced myocarditis and encephalitis.
• Successful treatment outcomes emphasize the importance of prompt intervention in managing these rare but serious adverse events.