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Abstract
We present a clinical case of development of several combined immune-related adverse events (irAEs), i. e. cardiotoxicity (acute myocarditis and pericarditis), pulmonitis, myositis, hematological syndrome and thyroiditis which occurred during the treatment of cutaneous melanoma with an immune checkpoint inhibitor (ICI) ― nivolumab.
A case of irAEs combinations, including those considered to be rare, such as myocarditis and hematological syndrome, developing on the background of cancerous symptoms, causes difficulties in diagnostics and can make it difficult to detect the existing pathology in time. This is why such cases require a mandatory involvement of specialized professionals, and there is a need for multidisciplinary cooperationю Moreover, the current case demonstrates the possibility of adding an examination of the musculocutaneous flap to the diagnostic algorithm of ICI-related myocarditis. This will be an additional argument in favor of a diagnosis of myocarditis rather than other cardiotoxic or concomitant heart lesions in case of a confirmed immune inflammation of the muscle ― myositis. The problems of the duration of glucocorticoid therapy and the possibility of continuing immunotherapy in cases of cardiotoxic irAEs of various gradex are discussed
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