PERICARDITIS IN A PATIENT ON PEMBROLIZUMAB

Abstract

TYPE: Case Report TOPIC: Cardiovascular Disease INTRODUCTION: Pembrolizumab, an immune check point inhibitor (ICI) reverses the T-cell suppression and induces antitumor responses. ICIs are associated with varity of immunity-related adverse effects (IRAEs) that can affect multiple organ systems. However cardiotoxicity, hematological complications, venous thromboembolism, and pulmonary toxicity are less well recognized. CASE PRESENTATION: A 44-year male with squamous cell carcinoma of lungs presented with complaints of non-radiating chest pain and shortness of breath on exertion. The patient received 45th cycle of pembrolizumab, two weeks prior to this presentation. Physical examination was within normal limit. Vital signs were stable. Laboratory values revealed normal electrolytes, troponin, and elevated C-reactive protein. Electrocardiogram revealed ST segment elevations in lead I, aVL and V4-V6. Anti-platelet agents were started and cardiac catheterization revealed normal coronary arteries. The echocardiogram showed small circumferential pericardial effusion. He was then started on corticosteroids and colchicine for acute pericarditis. After ruling out other possibilities it was believed to be IRAEs from pembrolizumab. Patient clinically improved with no additional intervention and was discharged on anti-inflammatory agents for acute pericarditis to prevent recurrence. DISCUSSION: The IRAEs are triggered by the activation of autoimmune system by T-cell activation. Pericardial effusion during PD-1 inhibitor treatment of lung cancer is exceedingly rare and has been reported in only about ten cases so far. These reports indicated the reasons for pericardial effusion as pesudoprogression or IRAEs. Most of these patients underwent invasive management and only one case was managed using corticosteroids without requiring invasive intervention. CONCLUSIONS: Pericarditis should be considered in a patient on prebrolizumab preseting with chest pain. DISCLOSURE: Nothing to declare. KEYWORD: Pericarditis