Double Trouble: Myocarditis After Dual Checkpoint Inhibitors

1 male patient aged 68 years with hypertension and metastatic renal cell carcinoma presenting with fulminant myocarditis and myasthenia gravis overlap after dual immune checkpoint inhibitor therapy, followed for 116 days until death.

Initial pulse-dose methylprednisolone (1 g/day for 3 days) and dual-chamber pacemaker implantation, followed by oral prednisone 120 mg (1 mg/kg) daily; upon readmission and decompensation, escalation to methylprednisolone 2 mg/kg daily for 2 days, IV mycophenolate mofetil 500 mg twice daily (later converted to oral), a single 5 mg/kg infliximab infusion, amiodarone, vasopressor support (norepinephrine), and mechanical ventilation; subsequent treatment for myasthenic crisis included multiple rounds of IVIG, pyridostigmine, and plasmapheresis.

Clinical course and survival following multi-agent immunosuppressive therapy for steroid-refractory ICI myocarditis and concurrent myasthenia gravis over 116 days after initial hospital presentation.hard clinical