SHM Converge Scientific Abstract ePoster Gallery-Heart & Muscles & Nerves, Oh My

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This discussion emphasizes the importance of considering immune checkpoint inhibitor (ICI) toxicity in patients with cancer who develop new symptoms, even if chest pain is absent and medication history is incomplete. Elevated troponin should prompt evaluation for non-ischemic causes such as myocarditis, and negative myasthenia gravis antibodies do not exclude immune-mediated disease.<br /><br />The case highlights the need to review oncologic history carefully, including prior or recent immunotherapy, because these agents can cause a wide range of adverse effects that may present at any time after administration. Early recognition is especially important for ICI-induced myocarditis and myositis. Myocarditis can lead to arrhythmias, heart failure, and high mortality; many patients have reduced ejection fraction on echocardiography. Prompt cardiology involvement and high-dose steroids are critical. ICI-related myositis typically causes proximal muscle weakness and elevated creatine kinase, may progress to rhabdomyolysis, and is also treated early with immunosuppression.<br /><br />In this case, the patient had bradycardia and ST depressions, received aspirin, clopidogrel, heparin, and steroids, and underwent cardiac catheterization. Later studies showed cardiac MRI findings consistent with myocardial injury and nerve conduction testing suggesting irritable myopathy (myositis). Paraneoplastic and extended myositis panels were negative. Despite treatment with pulse-dose steroids and IVIG, the patient’s condition continued to worsen, requiring less ventilatory support but not recovery. After continued decline, care was transitioned to comfort measures and the patient was palliatively extubated, passing away shortly thereafter.<br /><br />Overall, the case underscores the need for early diagnosis of ICI-related myocarditis and myositis to improve outcomes.

Asset Subtitle

April Banayan

Meta Tag

Author List April Banayan, Eric H. Yang, William Cope

Category Clinical Vignettes

Concept Myocarditis

Concept Immune Checkpoint Inhibitor

Concept Immune Checkpoint InhibitorAssociated Myocarditis

Concept Immune-Mediated Myositis

Concept Troponin

Distinguished Non-Finalist

Presenter Organization Ucla

Presenting Author April Banayan

Track Adult

Keywords

immune checkpoint inhibitor

ICI toxicity

myocarditis

myositis

troponin elevation

cardiac MRI

bradycardia

high-dose steroids

IVIG

immunotherapy adverse effects

Myocarditis

Immune Checkpoint Inhibitor

Immune Checkpoint InhibitorAssociated Myocarditis

Immune-Mediated Myositis

Troponin