JACC Case Rep. 2025 Dec 11:106488. doi: 10.1016/j.jaccas.2025.106488. Online ahead of print.
ABSTRACT
BACKGROUND: The optimal timing and indications for corticosteroid therapy in patients with suspected immune checkpoint inhibitor (ICI)-associated myocarditis and isolated cardiac troponin (cTn) elevation remain unclear.
CASE SUMMARY: A 67-year-old man with recurrent esophageal cancer developed marked cTnI elevation (6,714 pg/mL) 3 weeks after the first nivolumab-ipilimumab cycle. The patient was asymptomatic but was suspected to have ICI-associated myocarditis. Steroid pulse therapy was promptly initiated, and after 5 days, cardiac magnetic resonance imaging confirmed myocarditis. His cTnI levels normalized within 2 weeks, and cardiac function was preserved.
DISCUSSION: This case highlights the potential benefits of immediate steroid pulse therapy in asymptomatic patients with suspected ICI myocarditis. Treatment before diagnostic confirmation may prevent disease progression.
TAKE-HOME MESSAGES: Even in asymptomatic patients, early corticosteroid therapy should be considered for isolated cTn elevation suggesting ICI-associated myocarditis. Institutional awareness and preparedness for early intervention are crucial for effective allocation of short-term intensive medical resources.
PMID:41379051 | DOI:10.1016/j.jaccas.2025.106488