PDF(Pubmed)
Abstract：
Immune checkpoint inhibitors (ICIs) are a form of immunotherapy increasingly utilized in cancer therapies. While offering promise in malignancy treatment, ICIs, including atezolizumab, can elicit immune-related adverse events (irAEs) such as cardiotoxicity. We present the case of a 67-year-old male with stage IV metastatic small-cell lung cancer undergoing carboplatin, etoposide, and atezolizumab therapy, who developed pericardial tamponade two months into treatment. Initially presenting with hypoxia on day three of his third treatment cycle, he was admitted due to multifocal pneumonia and subsequently diagnosed with pericardial tamponade stemming from a sizable pericardial effusion. Pericardiocentesis was performed, effectively resolving the tamponade. Infectious etiology was ruled out. Notably, there was no associated myocarditis, as evidenced by negative cardiac markers and magnetic resonance imaging (MRI) findings, and cytologic analysis of the pericardial fluid did not reveal malignant cells, indicating an isolated immunologic etiology for the pericardial effusion. Following successful management, including oxygen support and a prednisone taper, chemotherapy without immunotherapy was resumed after a one-week delay. This rare case underscores the significance of promptly utilizing multimodality imaging with timely cardiology intervention, a prompt pericardial fluid analysis in diagnosing cardiac irAEs, and management leading to improved patient outcomes.
摘要：
免疫检查点抑制剂（ICI）是一种越来越多地用于癌症治疗的免疫疗法。在提供恶性肿瘤治疗的同时，ICIs,包括阿妥珠单抗,可引发免疫相关不良事件（irAEs），如心脏毒性。我们介绍了一名67岁的男性，患有IV期转移性小细胞肺癌，正在接受卡铂治疗，依托泊苷,和阿妥珠单抗治疗，他在治疗两个月后出现了心包填塞。最初在他第三个治疗周期的第三天出现缺氧，他因多局灶性肺炎入院，随后因大量心包积液而被诊断为心包填塞。进行了心包穿刺术,有效解决填塞。排除了感染性病因。值得注意的是,没有相关的心肌炎,心脏标志物阴性和磁共振成像（MRI）发现证明，心包液的细胞学分析没有发现恶性细胞，指示心包积液的孤立的免疫学病因。成功管理后，包括氧气支持和强的松锥度，延迟1周后恢复未进行免疫治疗的化疗.这一罕见病例强调了及时利用多模态成像和及时心脏病学干预的重要性。快速心包液分析在诊断心脏iRAE中，和管理导致改善患者预后。
