Apical ballooning and cardiomyopathy in a melanoma patient treated with ipilimumab: a case of takotsubo-like syndrome

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• 作者：Benjamin P Geisler (1)
  Roy A Raad (1)
  Diana Esaian (1)
  Elad Sharon (2)
  David R Schwartz (1)
  
  1. New York University School of Medicine ; New York ; NY ; 10016 ; USA
  2. National Cancer Institute ; Bethesda ; 20892 ; MD ; USA
  
• 关键词：Takotsubo cardiomyopathy ; Ipilimumab [Supplementary concept] ; Melanoma ; Drug ; related side effects and adverse reactions
• 刊名：Journal for Immunotherapy of Cancer
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：3
• 期：1
• 全文大小：3,394 KB
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• 刊物主题：Oncology;
• 出版者：BioMed Central
• ISSN：2051-1426

文摘

Although animal studies have shown that the immunomodulator ipilimumab causes inflammation of the myocardium, clinically significant myocarditis has been observed only infrequently. We report a case of suspected acute coronary syndrome without a culprit lesion on cardiac angiography and takotsubo cardiomyopathy (TC)-like appearance on echocardiography in a patient with metastatic melanoma who received four standard doses of ipilimumab. Apical ballooning, hyperdynamic basal wall motion, systolic anterior motion of the mitral valve, and associated severe left ventricular outflow tract obstruction were present. Restaging with positron emission tomography-computed tomography done soon after discharge incidentally revealed increased fludeoxyglucose uptake in the apex. This case illustrates that a TC-like syndrome might be caused by autoimmune myocarditis after ipilimumab treatment although this was not biopsy-confirmed. Post-marketing surveillance should capture cardiac events occurring in patients treated with ipilimumab to better document and clarify a relationship to the drug, and biopsies should be considered. Physicians utilizing this novel agent should be aware of the potential for immune-related adverse events.