Key result
Pembrolizumab and enfortumab vedotin linked to severe myocarditis and myositis resolved by methylprednisolone and IVIG.
Case Report (n=1)
No
This case demonstrates the successful management of severe pembrolizumab and enfortumab vedotin-induced myocarditis and myositis using high-dose steroids and IVIG.
A 64-year-old male with coronary artery disease, hypertension, hyperlipidemia, obstructive sleep apnea, and right ureteral urothelial carcinoma presented with chest pain, neck weakness, and myalgias after his first cycle of pembrolizumab and enfortumab vedotin. He developed a non-ST-segment elevation myocardial infarction (NSTEMI) alongside suspected immune checkpoint inhibitor (ICI)-associated myocarditis and myositis. Initial tests showed elevated troponin at 568 ng/L, creatinine phosphokinase (CPK) at 3,332 U/L, and transaminases. ECG revealed anterolateral ST-segment depression and left anterior fascicular block. Cardiac catheterization confirmed 90% mid-left anterior descending (LAD) artery stenosis, treated with a drug-eluting stent, and endomyocardial biopsy verified focal moderate lymphocytic myocarditis with myocyte necrosis. Treatment with high-dose methylprednisolone and intravenous immunoglobulin led to improvement in symptoms, biomarkers, and cardiac function. He was discharged on prednisone taper, dual antiplatelet therapy, anticoagulation, and prophylaxis, with outpatient follow-up arranged.
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Lodha et al. (2026) conducted a case report in Urothelial carcinoma with immune checkpoint inhibitor-associated myocarditis (n=1). Pembrolizumab and enfortumab vedotin was evaluated. Pembrolizumab and enfortumab vedotin induced severe myocarditis and myositis in a 64-year-old male, which was successfully treated with high-dose methylprednisolone and intravenous immunoglobulin.
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