Department of Dermatology.
Department of Internal Medicine I, University Hospital of Regensburg, Regensburg, Germany.
J Immunother. 2018 Jan;41(1):35-38. doi: 10.1097/CJI.0000000000000190.
Checkpoint inhibitors induce a plethora of immune-related adverse events (irAEs) including autoimmune colitis, hepatitis, endocrinopathies, and rarer side effects like neuritis. Here, a case of autoimmune cardiomyopathy (grade 3 CTCAE) and myocarditis under combination therapy with nivolumab plus ipilimumab in a 72-year-old melanoma patient is reported. Treatment induced a partial response for 14 months. However, after 10 infusions the patient developed dyspnea, edema of the legs, ascites and a weight gain of 10 kg because of a decompensated heart insufficiency with a reduced ejection fraction from formerly 48%-50% to 15%. Ischemia and viral infections were ruled out. Histopathology showed hypertrophic myocarditis with interstitial lymphocytes. Prednisolone improved the patient's condition within 3 days, leading to a 25% and 30% ejection fraction after 2 and 8 weeks, respectively, and clinical symptoms subsided completely. Importantly, reinduction of anti-PD1 therapy resulted in a flare of myocarditis. Awareness for potentially life-threatening irAE of checkpoint inhibitors like autoimmune cardiomyopathy and myocarditis is crucial to rapidly initiate adequate treatment.
检查点抑制剂会引发大量免疫相关不良事件（irAE），包括自身免疫性结肠炎、肝炎、内分泌疾病，以及神经炎等罕见的副作用。在此，报告了一例 72 岁黑色素瘤患者接受纳武单抗联合伊匹单抗联合治疗后发生自身免疫性心肌病（3 级 CTCAE）和心肌炎的病例。治疗诱导了 14 个月的部分缓解。然而，在 10 次输注后，由于心脏射血分数从以前的 48%-50%下降到 15%，患者出现呼吸困难、腿部水肿、腹水和体重增加 10 公斤，导致心功能失代偿，出现心力衰竭。排除了缺血和病毒感染。组织病理学显示心肌肥大伴间质淋巴细胞浸润。泼尼松龙在 3 天内改善了患者的病情，分别在 2 周和 8 周后射血分数提高了 25%和 30%，临床症状完全缓解。重要的是，重新诱导抗 PD-1 治疗导致心肌炎加重。对检查点抑制剂（如自身免疫性心肌病和心肌炎）潜在致命性 irAE 的认识对于快速启动适当的治疗至关重要。
