SHM Converge Scientific Abstract ePoster Gallery-Cemiplimab-Induced Myocarditis: A Rare but Severe Immune-Related Cardiotoxicity Presenting With Acute Lv Dysfunction

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This case report describes a 67-year-old woman with recurrent cutaneous squamous cell carcinoma treated with cemiplimab, an anti-PD-1 immune checkpoint inhibitor. After just one treatment cycle, she developed immune-related adverse events, including severe myalgia and transaminitis, and her prednisone taper was followed by progressive worsening fatigue, dyspnea, and leg edema.<br /><br />On hospital admission, she showed signs of acute heart failure with volume overload, sinus tachycardia, markedly elevated NT-proBNP and troponin, and elevated inflammatory markers. Echocardiography revealed global left ventricular hypokinesis, mild dilation, and a severely reduced ejection fraction of 25–30%. Cardiac catheterization showed normal coronary arteries, supporting a non-ischemic cause. Cardiac MRI demonstrated myocardial edema and non-ischemic late gadolinium enhancement, consistent with myocarditis. Endomyocardial biopsy showed lymphocytic infiltration with CD8+ T-cell predominance.<br /><br />She was treated promptly with pulse-dose intravenous methylprednisolone, leading to clinical improvement. Her hospital course was complicated by runs of ventricular tachycardia, premature ventricular contractions, and sinus tachycardia, managed with metoprolol and amiodarone. She was discharged on oral steroids, guideline-directed heart failure therapy, and a wearable cardioverter defibrillator. Follow-up echocardiography showed partial recovery of ventricular function to an ejection fraction of 45–50%, though she ultimately required ICD placement because of persistent ventricular arrhythmias.<br /><br />The report emphasizes that cemiplimab, while effective for advanced cancers, can rarely cause life-threatening immune checkpoint inhibitor myocarditis. Because this condition can progress rapidly and mimic other cardiac diseases, early recognition, immediate discontinuation of the drug, prompt immunosuppression, and close cardiac monitoring are essential.

Asset Subtitle

Mohamed Abdel Latif

Meta Tag

Author List Alexandre Papadopoulos, Mohamed Abdel Latif, Navid Dara, Vanessa Marshall

Category Clinical Vignettes

Concept Immune Checkpoint InhibitorAssociated Myocarditis

Concept Myocarditis

Concept Acute Heart Failure

Concept Cardiac Biopsy

Concept Drug Discontinuation

Distinguished Non-Finalist

Presenter Organization Baptist Memorial Hospital

Presenting Author Mohamed Abdel Latif

Track Adult

Keywords

cemiplimab

immune checkpoint inhibitor

myocarditis

cutaneous squamous cell carcinoma

heart failure

cardiac MRI

endomyocardial biopsy

ventricular tachycardia

methylprednisolone

ejection fraction

Immune Checkpoint InhibitorAssociated Myocarditis

Myocarditis

Acute Heart Failure

Cardiac Biopsy

Drug Discontinuation