SHM Converge Scientific Abstract ePoster Gallery-Can We Blame It All on the Immune Checkpoint Inhibitor?

Pdf Summary

This case describes an 80-year-old man with atrial fibrillation, COPD, hypertension, and stage IIIC malignant melanoma treated with nivolumab, who developed persistent pneumonitis after immunotherapy and later presented with worsening dyspnea and tachycardia. In the emergency department, he was found to have elevated troponin and BNP and atrial flutter with rapid ventricular response. Initial rate control with adenosine and diltiazem briefly helped, but his heart rate quickly returned to the 170s.<br /><br />The report highlights immune checkpoint inhibitor (ICI) toxicities, especially pneumonitis and cardiac complications. ICI-related pneumonitis occurs in about 3–5% of patients and may range from mild respiratory symptoms to severe respiratory failure. Risk is higher in patients with underlying lung disease or smoking history. Cardiac irAEs are less common but can include myocarditis, pericarditis, arrhythmias, and heart failure. Myocarditis is the most serious and often appears within weeks of starting therapy.<br /><br />During hospitalization, the patient developed a newly reduced left ventricular ejection fraction, raising concern for ICI-related cardiomyopathy. However, left and right heart catheterization showed non-obstructive coronary disease and normal right-sided pressures, and cardiac MRI made immunotherapy-induced cardiomyopathy unlikely. He was treated empirically with antibiotics for possible pneumonia and given a prolonged prednisone taper for pneumonitis. His arrhythmia was ultimately felt to be related to pneumonitis and secondary cardiomyopathy from rapid heart rate rather than direct ICI myocarditis.<br /><br />The case emphasizes the need for early recognition of irAEs and close collaboration among oncology, pulmonology, and cardiology.

Asset Subtitle

Yuhong Yang

Meta Tag

Author List Destiny Nguyen, Mary M. O'Sullivan, Nicole Morel, Yuhong Yang

Category Clinical Vignettes

Concept Immune-Related Adverse Event

Concept Immune Checkpoint Inhibitor

Concept Pneumonitis

Concept Cardiac Complication

Concept Diagnostic Approach

Distinguished Non-Finalist

Presenter Organization Mount Sinai West Hospital

Presenting Author Yuhong Yang

Track Adult

Keywords

atrial fibrillation

nivolumab

immune checkpoint inhibitor

pneumonitis

cardiotoxicity

atrial flutter

troponin elevation

heart failure

myocarditis

malignant melanoma

Immune-Related Adverse Event

Immune Checkpoint Inhibitor

Pneumonitis

Cardiac Complication

Diagnostic Approach