Pembrolizumab therapy in a 53-year-old woman with lung adenocarcinoma caused ICI-associated pericarditis and hepatitis, which resolved after ICI discontinuation and anti-inflammatory treatment.
Case Report (n=1)
Highlights the importance of considering ICI-associated pericarditis in patients on ICI therapy presenting with persistent pleuritic chest pain, emphasizing the role of multimodality imaging for diagnosis.
BACKGROUND: Immune checkpoint inhibitors (ICIs) such as pembrolizumab improve outcomes in metastatic non-small-cell lung cancer but can cause immune-related adverse events. Cardiovascular immune-related adverse events, including pericarditis, are rare and often underrecognized. CASE SUMMARY: A 53-year-old woman with recurrent metastatic lung adenocarcinoma on pembrolizumab presented with worsening pleuritic chest pain. Prior admissions attributed symptoms to pneumonia, pulmonary embolism, or malignancy. Laboratory studies showed elevated inflammatory markers and transaminitis; troponin was negative. Serial chest computed tomography demonstrated progressive pericardial thickening. Transthoracic echocardiography revealed a thickened pericardium, and cardiac magnetic resonance imaging confirmed pericardial inflammation without myocarditis. Liver biopsy supported concomitant ICI-related hepatitis. She was treated with nonsteroidal anti-inflammatory drugs, colchicine, and corticosteroids, with permanent discontinuation of ICIs. Follow-up imaging showed resolution. DISCUSSION: ICI-associated pericarditis requires high clinical suspicion, particularly in patients with lung cancer with overlapping etiologies for chest pain. Multimodality imaging and retrospective review of serial studies are critical for diagnosis. TAKE-HOME MESSAGES: Consider pericarditis in patients on ICI therapy with persistent pleuritic chest pain. Serial imaging review and early multimodality cardiac evaluation improve diagnostic accuracy and guide management.
Roy et al. (Mon,) conducted a case report in Immune checkpoint inhibitor-associated pericarditis (n=1). Pembrolizumab was evaluated. Pembrolizumab therapy in a 53-year-old woman with lung adenocarcinoma caused ICI-associated pericarditis and hepatitis, which resolved after ICI discontinuation and anti-inflammatory treatment.