Immune Checkpoint Inhibitor Myocarditis

초록

Background: ICIs have revolutionized oncology but can trigger rare (<1%) yet fatal (~50%) myocarditis. Clinical Presentation: Onset is usually early (within 1-2 cycles). Symptoms vary from mild fatigue to fulminant heart failure and arrhythmias, often overlapping with myositis or myasthenia gravis. Diagnosis: Troponin elevation is the most sensitive screening tool. ECG identifies conduction delays, while CMR detects myocardial edema and fibrosis. Endomyocardial biopsy remains the gold standard, revealing T-cell lymphocytic infiltration. Management: Immediate ICI cessation and high-dose pulse corticosteroids (methylprednisolone) are first-line. For refractory cases, second-line immunosuppressants like Abatacept or Infliximab should be initiated promptly. Conclusion: Early diagnosis through biomarker surveillance and a multidisciplinary cardio-oncology approach are vital to reducing the high mortality associated with ICI-induced myocarditis.