维迪西妥单抗与特瑞普利单抗联用致心肌炎

Myocarditis induced by the combination of disitamab vedotin and toripalimab

1例68岁女性浸润性尿路上皮癌患者术后接受免疫治疗(维迪西妥单抗120 mg+特瑞普利单抗240 mg静脉滴注、第1天,14 d为1个周期)。首次用药后19 d,患者诉腰部肌肉酸痛,实验室检查示肌酸激酶(CK)1079 U/L,CK⁃MB 33 U/L。暂停第2个周期免疫治疗,并予泼尼松20 mg口服、1次/d。5 d后,患者出现胸闷,实验室检查示CK 3366 U/L,CK⁃MB 91 U/L,乳酸脱氢酶518 U/L,肌红蛋白1282μg/L,高敏肌钙蛋白T 0.068μg/L,氨基末端脑利钠肽前体148 ng/L。结合心脏彩色多普勒超声检查结果,考虑为维迪西妥单抗和特瑞普利单抗联用所致心肌炎,将泼尼松换为甲泼尼龙160 mg静脉滴注、1次/d。患者上述实验室检查指标逐渐下降,但心电图检查示异位心律,给予胺碘酮等治疗。甲泼尼龙静脉滴注11 d后,改为甲泼尼龙片20 mg口服、1次/d(逐渐减量并停用)。停用激素后4 d复查,患者实验室指标和心电图未见异常。

A 68⁃year⁃old female patient with invasive urothelial carcinoma received immune treatments with disitamab vedotin 120 mg and toripalimab 240 mg intravenously on the first day,and 14 days was a cycle.Nineteen days after the first medication,the patient complained of lower back muscle sore⁃ness.Laboratory tests showed creatine kinase(CK)1079 U/L and CK⁃MB 33 U/L.The 2nd cycle of immuno⁃therapy was suspended and prednisone 20 mg orally once daily was given.Five days later,the patient felt chest tightness,and laboratory tests showed CK 3366 U/L,CK⁃MB 91 U/L,lactic dehydrogenase 518 U/L,myoglobin 1282μg/L,high⁃sensitivity troponin T 0.068μg/L,and N⁃terminal pro⁃brain natriuretic peptide 148 ng/L.Myocarditis caused by the combination of disitamab vedotin and toripalimab was considered,refer⁃ring to the cardiac color Doppler ultrasound examination.Prednisone was switched to IV infusion of methyl⁃prednisolone 160 mg once daily.The above laboratory test indicators gradually decreased,but the electro⁃cardiogram showed ectopic heart rhythm.Amiodarone was added.After 11 days of methylprednisolone treat⁃ment by IV infusion,methylprednisolone 20 mg orally once daily was given,which was gradually reduced and discontinued finally.Four days later,the patient′s laboratory indicators and electrocardiogram showed no abnormalities in the re-examination.