Immune checkpoint inhibitors can cause immune-related toxicity in various systems, and
myocarditis is the most serious life-threatening toxicity. This report introduces diagnosis and treatment of two cases which developed
myocarditis after receiving
PD-1 inhibitors therapy. The first case was a 77-year-old male with
chordoma, who was treated by third-line
sintilimab combined with
anlotinib, and presented with symptoms of chest tightness,
shortness of breath and upper
eyelid ptosis three weeks later. He was diagnosed as
immune-checkpoint-inhibitors-related
myocarditis and
myositis-
myasthenia-gravis overlap syndrome based on his clinical symptoms, serum
biomarkers, electrocardiogram, echocardiogram, and characteristic findings on cardiac
18F-FDG PET-MRI.
Methylprednisolone was given 480 mg/d initially and was gradually reduced to 40 mg/d in 4 weeks, with the myocardial injury
biomarkers declined in the same time. The second case was a 69-year-old female with advanced
non-small cell lung cancer, who was treated by
pemetrexed combined with
bevacizumab and
camrelizumab, and presented with palpitations 20 days later. She was diagnosed as
immune-checkpoint-inhibitors-related
myocarditis based on her clinical symptoms, serum
biomarkers, electrocardiogram and echocardiogram.
Methylprednisolone was given 240 mg/d initially and was gradually reduced to 40 mg/d with good response of myocardial injury
biomarkers decline. However, the patient developed fatal
myasthenia gravis afterwards, with little response to all treatments. These two cases revealed that, early detection and timely intervention, including discontinuation of
immune checkpoint inhibitors and initiation of adequate
steroid therapy, can reduce morbidity and mortality and improve prognosis.