Hellman Justin B, Traynis Ilana, Lin Lily Koo
a Department of Ophthalmology and Vision Science , University of California Davis Health Eye Center , Sacramento , CA , USA.
Orbit. 2019 Jun;38(3):244-247. doi: 10.1080/01676830.2018.1490439. Epub 2018 Jul 9.
We report the first case of fatal myocarditis presenting as bilateral ptosis in a patient on combination therapy with pembrolizumab and epacadostat. An 83 year-old man with stage III high-grade urothelial carcinoma presented with acute onset droopy eyelids one month after starting pembrolizumab and epacadostat. Exam showed myogenic ptosis and ophthalmoplegia. He was later found to have acute myocarditis with complete heart block and subsequently passed away. Pembrolizumab in combination with epacadostat can induce a potentially fatal myocarditis. Although immune mediated myocarditis is a rare established side effect, more reported fatalities are needed in the literature to highlight the urgency for standardized cardiac monitoring of even asymptomatic patients to prevent fatal outcomes, as well as a consensus on treatment protocols. Cancer immunotherapy complications are not well known to ophthalmologists. This case is unique in that the presenting sign was ptosis, which prompted the patient to call his ophthalmologist first.
我们报告了首例在接受派姆单抗和依帕司他联合治疗的患者中出现双侧上睑下垂的致命性心肌炎病例。一名83岁的III期高级别尿路上皮癌男性患者，在开始使用派姆单抗和依帕司他治疗一个月后出现急性发作的眼睑下垂。检查发现为肌源性上睑下垂和眼肌麻痹。他后来被诊断为急性心肌炎伴完全性心脏传导阻滞，随后去世。派姆单抗联合依帕司他可诱发潜在致命性心肌炎。尽管免疫介导的心肌炎是一种罕见的既定副作用，但文献中需要更多关于死亡病例的报道，以突出对即使无症状患者进行标准化心脏监测以预防致命后果的紧迫性，以及就治疗方案达成共识。癌症免疫治疗并发症对于眼科医生来说并不十分了解。该病例的独特之处在于其首发症状是上睑下垂，这促使患者首先联系了他的眼科医生。
