A case study of myopericarditis due to immune checkpoint inhibitor therapy: Proposed surveillance and management.
Nicole M Kuhnly, Jessica Shank Coviello
PMID 37000118WHAT IT FOUND
A 75-year-old man on pembrolizumab developed suspected myopericarditis and improved after IV Solumedrol, oral prednisone, colchicine, ibuprofen, and Bactrim with troponin-guided taper.
This is one course, not proof.
Key findings
01A 75-year-old man on pembrolizumab developed pericardial effusion and decreased left ventricular ejection fraction, and outpatient cardiac MRI showed myocarditis with LVEF 50%.
02He received intravenous Solumedrol, oral prednisone, colchicine, ibuprofen, and Bactrim prophylaxis; troponin was undetectable and LVEF was 58% at follow-up, but the case cannot separate the effect of any component.
03The article proposes weekly troponin and EKG for the first 6 weeks, every 2 weeks until week 22, then monthly while on treatment.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is a single case report, so it cannot show whether the treatment worked for others. The patient received intravenous Solumedrol, oral prednisone, colchicine, ibuprofen, and Bactrim prophylaxis together, so the contribution of any single component cannot be separated. The surveillance and management recommendations are proposed, not tested in this paper. Inpatient cardiac MRI was not completed because of orthopnea, so early imaging was delayed. There was no comparison group, so improvement cannot be measured against usual care.
The easy way to misread this
Do not read this as proof that steroids, colchicine, ibuprofen, Bactrim, or weekly troponin monitoring caused the improvement. This was one patient who received them together, and the paper does not test them.