Endo- and myocarditis as a severe complication of immune-related adverse event treatment: a case report

Disseminated Aspergillus infection is a severe condition in immunocompromised patients. Mortality secondary to cardiac Aspergillus infection remains high.

We present a case of a 45-year-old female breast cancer patient who developed Aspergillus fumigatus endocarditis and myocarditis after receiving the immune checkpoint inhibitor (ICI) pembrolizumab. The infection emerged as a complication following the management of a severe immune-related adverse event (irAE) with high doses of immunosuppressants, triggered by the ICI.

The use of ICIs and the subsequent treatment of irAEs with immunosuppressants introduce a new subset of immunocompromised patients at risk for fungal infections. While alternative corticosteroid-sparing immune-modulating agents such as biologicals, intravenous immunoglobulins, and disease-modifying anti-rheumatic drugs have been explored, there is lack of prospective studies evaluating their efficacy and safety in this context.