A Clinician’s Approach to Checkpoint Inhibitor Therapy Following Inflammatory Events from Nivolumab

With the growing number of monoclonal antibody therapies for oncologic conditions, timely identification and management of their complications are increasingly important for practitioners. This is a case of a 74-year-old female with primary metastatic melanoma who presented with progressive shortness of breath shortly after initiation of nivolumab. The patient’s endomyocardial biopsy was significant for myocyte damage with inflammatory infiltrate and positive PD-1 staining, indicating myocarditis. The hospital course was complicated by cardiac arrest leading to temporary pacemaker placement, atrial fibrillation with rapid ventricular rate, and concomitant thyroiditis. The patient was started on high-dose (1 mg/kg) steroids and mycophenolate for treatment of myocarditis.