Work

Immune Checkpoint Inhibitor–Associated Myocarditis Mimicking Takotsubo Cardiomyopathy

Year: 2025

Type: article

Abstract: BACKGROUND: Pembrolizumab-induced myocarditis is a rare but life-threatening immune-related adverse event. CASE SUMMARY: A 72-year-old woman with stage IV EGFR exon 19 deletion-positive left lung adenocarcinoma received osimertinib as first-line therapy. After disease progression, she underwent pembrolizumab plus pemetrexed-carboplatin as second-line therapy, then docetaxel plus ramucirumab as third-line therapy. She presented with nausea and anorexia, and electrocardiograms revealed widespread ST-segment elevation. Coronary angiography revealed no significant stenosis; left ventriculography revealed an apical ballooning pattern. Although Takotsubo cardiomyopathy was suspected, endomyocardial biopsy confirmed pembrolizumab-induced myocarditis. High-dose corticosteroids improved her cardiac function; however, the underlying malignancy progressed. DISCUSSION: Immune checkpoint inhibitor-associated myocarditis can mimic atypical Takotsubo cardiomyopathy, with persistent changes on electrocardiograms or elevated biomarkers, warranting endomyocardial biopsy for diagnosis and treatment with steroids. TAKE-HOME MESSAGE: In patients receiving immune checkpoint inhibitors, consider myocarditis in atypical Takotsubo presentations; biopsy and early steroids improve outcomes.

Source: JACC Case Reports

DOI: 10.1016/j.jaccas.2025.106131

Authors: Satoru Hiromasa, Yoshimichi Ueda, Takuya Mayumi, Hiroki Matsuoka, Tomoya Kaneda

Institution: Keiju Medical Center

Language: English

Topic: Cancer Immunotherapy and Biomarkers

Subfield: Oncology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $850