What is the clinical evidence from this study?

Study design: Case Report. Population: Hepatocellular carcinoma and immune checkpoint inhibitor-related myocarditis (n=1). Intervention: Sintilimab.

What does this research mean for the field?

The PD-1 inhibitor sintilimab can induce severe myocarditis in patients with hepatocellular carcinoma, which can be effectively diagnosed using cardiac magnetic resonance and endomyocardial biopsy, and successfully managed with high-dose corticosteroids. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

June 3, 2026Open Access

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

YZYuqiang ZhouLanzhou University ZZZhiliang ZhangUniversity of California, San Francisco SLShasha LiuFirst Hospital of Lanzhou University

Key Result

A 56-year-old man with hepatocellular carcinoma developed biopsy-proven myocarditis after two cycles of the PD-1 inhibitor sintilimab, which significantly improved following high-dose corticosteroid therapy.

Study Design

Type

Case Report (n=1)

Multicenter

Structured PICO

Population

A 56-year-old man with hepatocellular carcinoma who developed immune checkpoint inhibitor-related myocarditis after receiving two cycles of the PD-1 inhibitor sintilimab.

Exposure

Sintilimab (PD-1 inhibitor) two cycles, followed by high-dose corticosteroids and supportive therapy

Outcome

Development and clinical course of immune checkpoint inhibitor-related myocarditissafety

This case report demonstrates the successful diagnosis via CMR and EMB, and management with high-dose corticosteroids, of life-threatening myocarditis induced by the PD-1 inhibitor sintilimab.

Limitations

As it is a single case report, the conclusions cannot be generalized to broader populations.
Due to the patient's financial constraints, dynamic follow-up evaluation of post-treatment ECV and T2 values was not performed.
Considering the inherent tissue injury risk of endomyocardial biopsy, only one biopsy was conducted, and no follow-up biopsy was obtained after treatment.
The patient did not receive regular oncological follow-up for hepatocellular carcinoma after discontinuation of immunotherapy; therefore, the long-term prognosis and therapeutic response of the tumor could not be evaluated.

Abstract

Immune checkpoint inhibitors (ICIs) are pivotal in treating advanced malignancies, including hepatocellular carcinoma (HCC). However, they can trigger immune-related adverse events (irAEs), among which myocarditis is one of the most life-threatening. Herein, we report the case of a 56-year-old man with HCC who developed myocarditis after receiving two cycles of the PD-1 inhibitor sintilimab. The diagnosis was established via cardiac magnetic resonance (CMR) and confirmed by endomyocardial biopsy (EMB). Following treatment with high-dose corticosteroids and supportive therapy, the patient's condition exhibited significant improvement.

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