Immune checkpoint inhibitor-induced myocarditis with atrioventricular conduction abnormalities: a case report

Area of Science:

• Oncology
• Immunology
• Cardiology

Background:

• Immune checkpoint inhibitors (ICIs) are vital cancer therapies.
• Immune-related adverse events (irAEs), including myocarditis, are known complications.
• ICI-induced myocarditis is rare, potentially fatal, and may have atypical presentations.

Purpose of the Study:

• To describe a case of nivolumab-induced myocarditis in esophageal cancer.
• To highlight diagnostic and therapeutic challenges associated with ICI-induced myocarditis.
• To emphasize the importance of early detection and management of this irAE.

Main Methods:

• Case report of a patient with esophageal cancer undergoing adjuvant therapy with nivolumab.
• Detailed description of clinical presentation, diagnostic workup, and treatment.
• Focus on conduction abnormalities and neuromuscular symptoms.

Main Results:

• The patient developed high-grade atrioventricular block and neuromuscular symptoms.
• Diagnosis of nivolumab-induced myocarditis was established.
• Treatment involved immunosuppressive therapy and management of cardiac conduction issues.

Conclusions:

• ICI-induced myocarditis requires high clinical suspicion, even with subtle symptoms.
• Prompt diagnosis, comprehensive evaluation, and timely immunosuppression are critical.
• Individualized management of conduction disturbances is essential for favorable outcomes.