Multidisciplinary insight for managing immune checkpoint inhibitor-related myocarditis: a case report

Immune checkpoint inhibitors (ICIs) reverse immunoediting and help the host immune system to destroy cancer cells. The increased use of ICIs has led to the recognition of immune-related adverse events (iRAEs) that can affect almost every organ or system. ICI-related myocarditis a rare iRAE that tends to be severe and potentially life-threatening. Herein, we report the case of a patient with malignant melanoma who was treated with immunotherapy and showed signs of both focal segmental glomerulosclerosis and myocarditis. The patient underwent coronary angiography with endocardial biopsy, which failed to reveal ICI-related myocarditis. Because the chances of developing ICI-related myocarditis are higher when patients with cardiac symptoms also exhibit symptoms suggestive of other iRAEs, a decision was made to administer high-dose steroid therapy based on clinical suspicion. After following a protocol-based corticosteroid regimen, the patient showed significant improvement in myocarditis. This case report provides insight into the importance of clinical suspicion and a multidisciplinary approach for the diagnosis and management of irAEs.