Key result
VA-ECMO, abatacept, and plasma exchange restore ventricular function in late-presenting fulminant pembrolizumab-associated myocarditis.
Why the study?
Immune checkpoint inhibitor myocarditis typically presents early after initiating immunotherapy, and late-presenting fulminant cases are uncommon.
Case Report (n=1)
This case demonstrates that immune checkpoint inhibitor myocarditis can present unusually late and that early recognition, aggressive immunosuppression (including abatacept), and mechanical circulatory support can be lifesaving in fulminant cases.
May support aggressive multimodal therapy including abatacept and ECMO in fulminant late-onset ICI myocarditis; leaves open optimal strategies pending prospective data.
BACKGROUND: Immune checkpoint inhibitor (ICI) myocarditis is an uncommon but potentially fatal cardiovascular immune-related adverse event that typically presents early after initiating immunotherapy. CASE SUMMARY: A 36-year-old man with colorectal cancer treated with pembrolizumab presented with cardiogenic shock after 460 days of immunotherapy. Ultimately, he was found to have ICI myocarditis by clinical and histopathological criteria. Despite high-dose corticosteroids, he developed refractory hemodynamic and electrical instability requiring venoarterial extracorporeal membrane oxygenation, abatacept, and therapeutic plasma exchange, with successful recovery of ventricular function and resolution of conduction abnormalities. DISCUSSION: This case illustrates an unusually late, biopsy-confirmed, fulminant presentation of pembrolizumab-associated myocarditis and highlights the importance of maintaining suspicion for immune-related cardiotoxicity even late during immunotherapy. Early recognition and prompt immunosuppression combined with mechanical circulatory support may be lifesaving in such fulminant cases. TAKE-HOME MESSAGE: Early recognition, aggressive immunosuppression, and hemodynamic support are central to the management of ICI myocarditis.
No takes yet. Share an insight, caveat, or question.
Kikuchi et al. (2026) conducted a case report in Immune checkpoint inhibitor myocarditis (n=1). High-dose corticosteroids, venoarterial extracorporeal membrane oxygenation, abatacept, and therapeutic plasma exchange was evaluated on Recovery of ventricular function and resolution of conduction abnormalities. A 36-year-old man with late-presenting fulminant pembrolizumab-associated myocarditis successfully recovered ventricular function following treatment with VA-ECMO, abatacept, and plasma exchange.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: