Steroid-resistant immune checkpoint inhibitor-associated myocarditis: a case report

Abstract

Objective

Steroid-resistant immune checkpoint inhibitor (ICI)-associated myocarditis (ICIAM) is rare, with no effective therapy. We present a case of successfully managed steroid-resistant ICIAM, demonstrating an effective treatment for this life-threatening complication.

Case report

A 77-year-old woman with intrahepatic cholangiocarcinoma developed myocardial injury after two doses of ICI treatment. There was a rebound in troponin T during corticosteroid therapy; consequently, the patient was treated with tofacitinib combined with mycophenolate mofetil as second-line immunosuppressive therapy. Outcomes improved and anti-tumor treatment was rechallenged.

Conclusion

The early administration of second-line immunosuppressive therapy is crucial for good outcomes with steroid-resistant ICIAM and the subsequent rechallenge of anti-tumor therapy.

Keywords

Steroid-resistant / Immune checkpoint inhibitors associated myocarditis / Immunosuppressive therapy / Rechallenge / Mycophenolate mofetil

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Funding

National Natural Science Foundation of China(82170359)

National Natural Science Foundation of China(82470354)

Noncommunicable Chronic Diseases-National Science and Technology Major Project(2023ZD0502800)

Shanghai Shenkang Hospital Development Center municipal hospital diagnosis and treatment technology project(SHDC22023207)

Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences(2024-JKCS-28)

RIGHTS & PERMISSIONS

The Author(s)