Immune checkpoint inhibitor–related myocarditis in a patient with hepatocellular carcinoma: a case report

Figures

• 

  Figure 1. (A) Baseline ECG demonstrates nonspecific ST-segment changes, poor R-wave progression in leads V1-V3, a QRS duration of 108 ms, and a QTc interval of 450 ms. (B) ECG prior to the second ICI administration reveals a newly developed complete left bundle branch block (CLBBB), persistent nonspecific ST-segment changes, a QS pattern in leads V1-V4, a QRS duration of 152 ms, and a QTc interval of 493 ms. (C) ECG at the onset of myocarditis shows an intraventricular conduction delay, with a QRS duration of 167 ms and a QTc interval of 487 ms. (D) ECG following high-dose steroid therapy indicates resolution of the conduction abnormalities, with a QRS duration of 97 ms and a QTc interval of 428 ms, though nonspecific ST-segment changes persist.

• 

  Figure 2. (A) Four-chamber cine CMR reveals bilateral pleural effusions (red arrows). (B) The short-axis cine CMR measures a left ventricular end-diastolic diameter of 53.8 mm (red line). (C) The late gadolinium enhancement image shows no evidence of focal fibrosis. (D) T1 mapping demonstrates mildly elevated native T1 values, predominantly in the anterior wall and interventricular septum. (E) T2 mapping indicates significantly elevated T2 values, with a similar anterior and septal predominance. (F) Extracellular volume map reveals markedly increased values, particularly in the anterior wall and interventricular septum.

• 

  Figure 3. (A) Hematoxylin and eosin staining image shows cardiomyocyte hypertrophy, interstitial loosening, edema, and scant lymphocytic infiltration. (B) Immunohistochemical staining demonstrates the presence of CD3-positive T lymphocytes. (C) Immunohistochemical staining demonstrates the presence of CD4-positive T lymphocytes. (D) Immunohistochemical staining demonstrates the presence of CD68-positive macrophages (Magnification: × 400).