病例报告 致命性心肌炎与托利帕利马布和阿克西替尼结合疗法
Zhengxin Liu1, Jinyu Tian, Shengjie Zeng
1Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Medicine
|December 30, 2025
概括
免疫检查点抑制剂 (ICI) 治疗可以导致严重的心肌炎,危及生命的疾病. 早期识别,积极管理和感染预防对于接受组合免疫治疗的患者至关重要.
科学领域:
- 在瘤学瘤学.
- 免疫学 免疫学 免疫学
- 心脏病学 心脏病学
背景情况:
- 免疫检查点抑制剂 (ICI) 治疗引起的心脏免疫相关不良事件 (irAEs) 是罕见但严重的.
- 肌心炎是一种特定的心脏性心脏病发作,即使在密集治疗下,其死亡率也很高.
研究的目的:
- 在患有晚期细胞癌的患者中报告致命的高度ICI相关心肌炎病例.
- 强调早期诊断,积极管理和感染预防策略在管理这种并发症中的重要性.
主要方法:
- 一名65岁的男性患有晚期清晰细胞细胞癌,接受了组合免疫疗法 (托利帕利马布和阿克西替尼).
- 患者呈现心肌炎症状,通过临床发现,生物标志物,心声回声和排除感染来诊断.
- 治疗包括多模式免疫抑制 (甲基前尼索隆,IVIG,血交换) 和生命维持 (VA-ECMO),以及由微生物监测指导的抗生素.
主要成果:
- 尽管最初的血液动力学稳定通过积极的治疗,患者发展了严重的医院感染.
- 随后出现了渐进的多器官衰竭,导致患者在住院24天后死亡.
结论:
- 高度ICI相关心肌炎是一种危及生命的并发症,需要迅速识别和密集管理.
- 积极预防感染,包括微生物监测引导的抗生素预防,对于接受组合免疫疗法以减轻风险的患者至关重要.
- 这一案例突显了免疫疗法,心脏毒性和癌症患者感染之间的复杂相互作用.
相关概念视频
Myocarditis III: Medical Management
153
Myocarditis: Comprehensive Medical ManagementMyocarditis, the heart muscle inflammation, requires a comprehensive medical management strategy that addresses the underlying cause, provides supportive care, manages symptoms, and reduces cardiac workload.Infections and Autoimmune CausesAdminister appropriate antimicrobial therapy when an infectious agent causes myocarditis. For instance, penicillin treats infections caused by Group A Streptococcus. In cases where autoimmune processes are...
153
Myocarditis II: Clinical Features and Diagnostic Tests
229
Myocarditis is an inflammation of the heart muscle. The symptoms vary widely, encompassing asymptomatic presentations to severe, acute manifestations.Clinical PresentationAsymptomatic cases: In some instances, myocarditis may be asymptomatic, with the infection resolving without intervention. These cases often go undetected unless discovered incidentally through diagnostic imaging or tests conducted for other reasons.General Early Symptoms: Early symptoms of myocarditis are non-specific and can...
229
Myocarditis IV: Nursing Management
190
Myocarditis is an inflammatory condition of the myocardium requiring meticulous nursing management for optimal patient outcomes. Effective management begins with a thorough assessment of the patient's medical history, paying close attention to past infections, autoimmune disorders, travel history, and exposure to toxins or drugs. Recent viral infections and systemic diseases are particularly relevant due to their potential role in triggering myocarditis.Physical Examination and MonitoringThe...
190
Pericarditis III: Medical Management
269
The primary objectives of managing pericarditis are to determine the underlying cause, provide effective therapy for treatment and symptom relief, and promptly detect signs and symptoms of cardiac tamponade. The following outlines the essential aspects of medical management for pericarditis:ObjectivesDetermine the Cause: Identifying the underlying cause of pericarditis is crucial for targeted treatment. Causes include viral infections, autoimmune diseases, post-cardiac injury syndrome, and...
269
Myocarditis I: Introduction
328
Myocarditis is inflammation of the myocardium, which is the muscular layer of the heart.EtiologyMyocarditis has a diverse etiology, including a wide range of infectious and non-infectious causes:Infectious CausesViral: Common viruses include Coxsackie A and B, adenovirus, parvovirus B19, enteroviruses, and influenza A.Bacterial: Examples include infections caused by Streptococcus, Staphylococcus, and Mycoplasma species.Rickettsial: Infections like Rocky Mountain spotted fever can result in...
328
Tumor Immunotherapy
1.7K
Immunotherapy is a treatment that boosts or manipulates the immune system to fight diseases, including cancer. For instance, by stimulating an immune response through vaccinations against viruses that cause cancers, like hepatitis B virus and human papillomavirus, these diseases can be prevented. Nonetheless, some cancer cells can avoid the immune system due to their rapid mutation and division. The immune response to many cancers involves three phases: elimination, equilibrium, and escape.
1.7K
