The Dyspnea Dilemma: Immune Checkpoint Inhibitor-Associated Myocarditis Mimicking Overlapping Cardiac Pathologies-A...

Area of Science:

• Cardiology
• Oncology
• Immunology

Background:

• Immune checkpoint inhibitors (ICIs) improve survival in solid tumors but rarely cause fulminant myocarditis.
• Myocarditis diagnosis is challenging due to clinical overlap with other cardiac conditions like coronary artery disease (CAD).

Purpose of the Study:

• To highlight the diagnostic challenges of dyspnea in oncology patients.
• To emphasize the importance of a multidisciplinary approach in diagnosing cardiac complications of ICI therapy.

Main Methods:

• Case presentation of a patient with gallbladder adenocarcinoma on ICI therapy presenting with dyspnea, edema, and chest pain.
• Utilized echocardiography, coronary angiography, and cardiac MRI for diagnosis.
• Employed a multidisciplinary team approach for patient management.

Main Results:

• Cardiac MRI confirmed diffuse myocardial edema consistent with myocarditis.
• Obstructive CAD was excluded by coronary angiography.
• Patient showed symptomatic improvement after high-dose corticosteroid initiation.

Conclusions:

• Dyspnea in oncology patients can stem from multiple cardiac pathologies requiring systematic evaluation.
• Clinicians must suspect ICI myocarditis in patients with new heart failure or wall motion abnormalities without obstructive CAD.
• Early immunosuppressive therapy is critical for managing ICI-associated myocarditis.