Late-Onset Fulminant Myocarditis With Immune Checkpoint Inhibitor Nivolumab.

Abstract

A 60-year-old man was diagnosed with melanoma. After receiving 13 infusions of nivolumab, he had fulminant myocarditis. The myocardial biopsy specimen revealed extensive lymphocytic infiltration, interstitial edema, and myocardial necrosis, with predominant CD4+, CD8+, CD20-, and programmed death-1- markers. Programmed death-1 ligand 1 (PD-L1) was predominantly expressed on the surface of the damaged myocardium. Although it is reported that myocarditis induced by the human anti-programmed death-1 inhibitor nivolumab therapy rarely occurred at > 2 months use in clinical trials, this case showed that even if at a late phase, long-term use of immune checkpoint inhibitors might to lead immune-related adverse events including myocarditis.

• Authors: Shogo Yamaguchi, Ryota Morimoto, Takahiro Okumura, Yuta Yamashita, Tomoaki Haga, Tasuku Kuwayama, Tsuyoshi Yokoi, Hiroaki Hiraiwa, Toru Kondo, Yuki Sugiura, Naoki Watanabe, Naoaki Kano, Kei Kohno, Kenji Fukaya, Akinori Sawamura, Kenji Yokota, Hideki Ishii, Masato Nakaguro, Masashi Akiyama, Toyoaki Murohara
• Journal: The Canadian journal of cardiology (Can J Cardiol) Vol. 34 Issue 6 Pg. 812.e1-812.e3 (06 2018) ISSN: 1916-7075 [Electronic] England
• PMID: 29801747 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2018 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Chemical References

• Antineoplastic Agents, Immunological
• B7-H1 Antigen
• Glucocorticoids
• Immunoglobulins, Intravenous
• PDCD1 protein, human
• Programmed Cell Death 1 Receptor
• Nivolumab
• Prednisolone

Topics

• Antineoplastic Agents, Immunological (administration & dosage, adverse effects)
• B7-H1 Antigen (analysis)
• Glucocorticoids (administration & dosage)
• Humans
• Immunoglobulins, Intravenous (administration & dosage)
• Intra-Aortic Balloon Pumping (methods)
• Long Term Adverse Effects (chemically induced, pathology, physiopathology, therapy)
• Male
• Melanoma (diagnosis, drug therapy)
• Middle Aged
• Myocarditis (chemically induced, pathology, physiopathology, therapy)
• Myocardium (pathology)
• Nivolumab (administration & dosage, adverse effects)
• Prednisolone (administration & dosage)
• Programmed Cell Death 1 Receptor (antagonists & inhibitors)
• Pulse Therapy, Drug (methods)
• Treatment Outcome