Abstract
A 37-year-old female with sarcoma on pembrolizumab experienced lightheadedness during hospitalization. Telemetry revealed Torsades de pointes (TdP) that lasted 3.8 seconds (Figure 1). Her potassium, magnesium and troponin were normal. Admission EKG was sinus bradycardic at 44 bpm with a QTc of 478 ms. Cardiac MRI revealed subtle focal myocardial edema in the left ventricular septal wall suspicious for mild myocarditis likely secondary to pembrolizumab. The patient was given 2 grams of intravenous magnesium sulfate and initiated on methylprednisolone 1 mg/kg intravenously daily. She had no further lightheadedness or episodes of TdP. She was discharged on a course of tapering oral prednisone. Patient was also instructed to avoid all QT prolonging medications. Her pembrolizumab was discontinued. The patient was still asymptomatic at follow-up in five weeks and her QTc had decreased to 388 ms.
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