一名患有转移性黑色素瘤的 54 岁女性因模仿浸润性心肌病而患上致命的免疫检查点抑制剂相关心肌炎

Sakhi Hichem, Chevance Virgile, Kalifa Laurette, Arana Riad, Laparra Ariane, Reverdito Guillaume, Salem Fares Ben, Pottier Charles, Lambotte Olivier, Azarine Arshid, Smaali Sondes
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摘要

简介免疫检查点抑制剂(ICI)大大改善了癌症治疗效果,但ICI相关心肌炎等心血管并发症也是一个主要问题。诊断心肌炎需要结合生物标记物、心电图(EKG)、心脏成像和心内膜活检。我们提供了一个病例来说明这些诊断难题,该病例涉及一名接受 pembrolizumab 治疗的女性患者,她患上了模仿浸润性心肌病的致命性急性心肌炎。病例报告:一名 54 岁的女性患者患有粘膜黑色素瘤,曾接受过 pembrolizumab 治疗,因呼吸困难和肌钙蛋白水平升高于 2023 年 5 月入院。最初的心脏检查结果正常,但随后的检查发现心脏磁共振成像结果呈边缘性。2023 年 5 月下旬,患者因呼吸困难加重、NT-pro-BNP 升高和严重的高乳酸血症入院。影像学检查和心内膜活检证实患者患有急性心肌炎,表现不典型,酷似浸润性心肌病。尽管患者接受了积极的免疫抑制治疗,但病情仍不断恶化,最终导致心源性休克,入院七天后死亡。结论:本病例强调了 ICI 相关性心肌炎在诊断和治疗方面的挑战,尤其是非典型性表现。它强调了对接受 ICI 治疗的患者进行警惕性全面监测和进一步研究以改进诊断和治疗策略的必要性,从而控制这些严重的副作用。
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Fatal Immune Checkpoint Inhibitor-associated Myocarditis Mimicking Infiltrative Cardiomyopathy in a 54-year-old Woman with Metastatic Melanoma
Introduction: Immune checkpoint inhibitors (ICI) have significantly improved cancer treatment outcomes, but cardiovascular complications such as ICI-associated myocarditis are a major concern. Diagnosing myocarditis requires integrating biomarkers, electrocardiogram (EKG), cardiac imaging, and endomyocardial biopsy. We present a case illustrating these diagnostic challenges, involving a female patient treated with pembrolizumab who developed fatal acute myocarditis mimicking infiltrative cardiomyopathy. Case report: A 54-year-old woman with mucosal melanoma, treated with pembrolizumab, was hospitalized in May 2023 due to dyspnea and elevated troponin levels. Initial cardiac workups were normal, but subsequent tests revealed borderline cardiac magnetic resonance imaging findings. In late May 2023, the patient was admitted with worsening dyspnea, elevated NT-pro-BNP, and severe hyperlactatemia. Imaging and endomyocardial biopsy confirmed acute myocarditis with atypical presentation, mimicking infiltrative cardiomyopathy. Despite aggressive immunosuppressive therapy, the patient’s condition deteriorated, resulting in cardiogenic shock and death seven days post-admission. Conclusion: This case underscores the diagnostic and management challenges of ICI-associated myocarditis, particularly with atypical presentations. It highlights the need for vigilant, comprehensive monitoring and further research to improve diagnostic and therapeutic strategies for managing these severe side effects in patients undergoing ICI therapy.
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