Fulminant Myocarditis After Initial Pembrolizumab Treatment for Squamous Cell Carcinoma of the Lung: an Autopsy Case Report

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  • Pembrolizumab初回投与後に劇症型心筋炎を発症して死亡した肺扁平上皮癌の1剖検例

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Abstract

<p>Background. While pembrolizumab has come to be recognized as an important agent for the treatment of non-small cell lung cancer in recent years, various immune-related adverse events have been reported and should be carefully followed. Case. A man in his 60s was admitted to our hospital because of cough and breathlessness. Chest computed tomography showed a mass extending from the right hilum to the anterior mediastinum, right pleural effusion, and pericardial effusion. A thoracoscopic biopsy was performed. The histological diagnosis was squamous cell carcinoma with a high tumor expression of PD-L1 (tumor proportion score of 100%). We made the diagnosis of right upper lobe lung cancer (cT4N1M1a cStage IVA) and started the patient on pembrolizumab monotherapy. On day 13, the patient developed pyrexia and malaise and was readmitted to the hospital with suspected myocarditis. As his cardiac function was relatively well-preserved, administration of diuretics was initiated. On day 16, the patient went into shock and was admitted to the intensive-care unit. Mechanical cardiopulmonary support and ventricular pacing were started. Intravenous steroid therapy was started on day 17. The treatments proved ineffective, and the patient died on day 18. An autopsy revealed that the myocarditis was consistent with an immune-related adverse event, as the myocardial tissue showed infiltration of CD8-positive lymphocytes. Rhabdomyolysis was also confirmed. Conclusion. We report the case of a patient who developed fulminant myocarditis, supposedly as an immune-related adverse reaction to pembrolizumab. As underscored by the clinical course in this case, it is important to make an early diagnosis in close cooperation with the related departments and promptly start appropriate treatment.</p>

Journal

  • Haigan

    Haigan 60 (4), 335-340, 2020-08-20

    The Japan Lung Cancer Society

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