Myocardial Immune Vulnerability Unmasked after Treatment with Immune Checkpoint Inhibitors: A Case Report

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ID: 323629
2026
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Abstract
Abstract Background Although uncommon (incidence <1%), cardiac immune-related adverse events (irAEs) associated with immune checkpoint inhibitor (ICI) therapy can be fatal. Their underlying mechanisms remain incompletely understood, although autoimmune predisposition and cross-antigen responses have been implicated. Case summary We report the case of a young, immunologically predisposed patient with renal cell carcinoma who developed recurrent episodes of myocardial injury following an initial mild ICI-related myocarditis. Subsequent viral infections acted as triggers for repeated myocardial damage despite discontinuation of ICI therapy. Discussion Novel immune biomarkers were identified, and distinctive findings on endomyocardial biopsy, together with tumour protein expression patterns, provided insight into the patient’s heightened myocardial immune vulnerability to viral infections. This case highlights the complex interplay between ICI therapy, host immune predisposition, and viral triggers in the pathogenesis of cardiac irAEs.
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Authors Eduardo Zatarain‐Nicolás, L I Yousif, Francisco Díaz‐Crespo, Enrique Ortega‐Sollero, Jóse Ángel Arranz Arija, Javier Bermejo, Pilar Martı́n, Wouter C. Meijers
Journal European Heart Journal - Case Reports
Year 2026
DOI
10.1093/ehjcr/ytag579
URL
https://doi.org/10.1093/ehjcr/ytag579
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