Brugada-like Arrhythmia and Suspected Myocarditis Following Immune Checkpoint Inhibitor Therapy in a Patient with Metastatic Renal Cell Carcinoma: A Case Report

Abstract Immune checkpoint inhibitors (ICIs) have revolutionized cancer therapy, but their immune-activating properties can precipitate a diverse array of immune-related adverse events (irAEs) [2,3,8]. We present the case of a 41-year-old woman with metastatic renal cell carcinoma (mRCC) who, following treatment with ipilimumab and nivolumab, developed Brugada-like ventricular arrhythmias and suspected myocarditis, a rare but potentially fatal cardiovascular irAE [2,4,7]. Initially presenting with ventricular tachycardia (VT) and diabetic ketoacidosis after three cycles of ICI therapy, coronary angiography revealed a flow-limiting lesion necessitating percutaneous coronary intervention (PCI). Despite successful revascularization and optimal medical management, she experienced recurrent VT. Electrocardiographic (ECG) findings revealed a Brugada pattern [5], prompting initiation of quinidine and implantation of an implantable cardioverter-defibrillator (AICD) [12,13,14]. Suspecting ICI-induced myocarditis, she was treated with corticosteroids [10,11], which resulted in the resolution of VT. This case underscores the importance of heightened vigilance for cardiac irAEs, including Brugada-like arrhythmias, in patients receiving ICIs [2,4,15,16]. Early recognition, prompt diagnosis, and multidisciplinary management are crucial for mitigating the risk of these potentially life-threatening complications [3,6,18]. Further research is needed to delineate the underlying mechanisms and optimize treatment strategies for ICI-induced Brugada-like arrhythmia [2,4].