부산대학교 도서관

Background Immune checkpoint inhibitors (ICIs) have markedly improved outcome in various types of cancer. ICI-associated myocarditis is one of the most severe immune-related adverse events. In particular, high concentrations of cardiac troponin T (cTnT) are associated with a high risk of death and early detection and vigorous therapy with high-dose steroids may improve survival. However, chronic skeletal muscle disorders have been suggested as a non-cardiac source of elevated high-sensitivity cardiac troponin T (hs-cTnT) concentrations. Case summary Here, we present the case of a 72-year-old patient with metastatic melanoma treated with nivolumab and ipilimumab, who developed symptomatic myositis [creatine kinase (CK) max. 3113 U/L]. Due to substantially elevated concentrations of hs-cTnT (max. 1128 ng/L, normal Discussion Our observation documents ICI-induced myositis as an alternative non-cardiac cause of hs-cTnT elevation. A global cardiologic approach employing clinical and cardiac magnetic resonance imaging data as well as NT-proBNP and cardiac troponin I helps to identify false positive hs-TnT elevation under ICI therapy. Keywords Case report * Immune checkpoint inhibitors * Immune-related adverse events * Myocarditis * Troponin * Biomarker * Myositis ESC curriculum 6.9 Cardiac dysfunction in oncology patients * 2.3 Cardiac magnetic resonance
Learning points * Immune-related myositis is an important alternative non-cardiac cause of hs- cardiac troponin T (cTnT) elevation in cancer patients undergoing immune checkpoint inhibitor (ICI) treatment. * A global [...]