Myocarditis induced by durvalumab in a patient with hepatocellular carcinoma: A case report

Durvalumab is an immune checkpoint inhibitor that targets PD-L1 and is used for malignancies such as hepatocellular carcinoma. Although effective, it may cause immune-related adverse events, including rare cases of myocarditis (0.06% to 1%), which usually appear early. This complication results from immune response-induced damage to the myocardium, highlighting the importance of prompt detection and management to prevent potentially fatal outcomes. This report describes a 70-year-old woman with advanced hepatocellular carcinoma who developed myocarditis after receiving a single dose of durvalumab. The patient presented with atypical chest pain, shortness of breath, and gastrointestinal symptoms. Initial investigations revealed elevated cardiac biomarkers, including Troponin I and CK-MB, and an ECG showing sinus tachycardia and right bundle branch block. A cardiac MRI confirmed non-ischemic myocardial injury, leading to a diagnosis of ICI-induced myocarditis. The patient was treated with high-dose corticosteroids, resulting in rapid clinical improvement and stabilization of cardiac function. A multidisciplinary approach involving cardiology, oncology, and clinical pharmacy was crucial in managing this complex case. This case highlights the importance of heightened vigilance among healthcare providers when administering ICIs, particularly durvalumab, due to the risk of myocarditis. Early detection and prompt intervention are essential to manage ICI-related adverse events and prevent severe outcomes. The successful treatment of this patient demonstrates the importance of a multidisciplinary approach in tackling the complexities of ICI-induced myocarditis. Further research is necessary to optimize management strategies and follow-up protocols for patients experiencing this rare but serious adverse event.