帕博利珠单抗相关爆发性心肌炎一例

A case of fulminant myocarditis associated with pembrolizumab

免疫检查点抑制剂(ICIs)是近年来肿瘤治疗领域的最重要进展之一。随着ICIs适应证的不断拓展及国内原研药相继进入临床,ICIs将用于越来越多的肿瘤患者,然而ICIs的严重不良反应尚未引起临床医师的广泛关注。该文报道1例肝癌术后复发接受帕博利珠单抗治疗引起爆发性心肌炎的病例,患者主要表现为心肌酶升高,难治性心律失常,伴有肝损伤,呼吸衰竭等,虽经积极抢救最终死亡。该例提示ICIs相关免疫性心肌炎早期症状不典型,但疾病呈爆发性进展,需要临床医师早期识别,及早干预。

Immune checkpoint inhibitors(ICIs)have become one of the most important advances in tumor therapy in recent years.With continuous expansion of the indications of ICIs and the introduction of domestic original drugs into clinical practice,ICIs will be applied in more and more tumor patients.However,severe adverse reactions of ICIs have not captivated widespread concerns among clinicians.In this article,we reported 1 case of fulminant myocarditis caused by pembrolizumab for treating postoperative recurrence of liver cancer.The main manifestations of this patient included elevated level of myocardial enzymes,refractory arrhythmia complicated with liver injury and respiratory failure,etc.The patient died even after active treatment.This case hints that early symptoms of ICIs-associated myocarditis are not typical,which can progress in a fulminant pattern.Prompt identification and intervention should be delivered by clinicians.