Latsios G, Dimitroglou Y, Lazaros G, Alexopoulos N, Tolis I, Aggeli C, Tsioufis C. Differentiating between immune checkpoint inhibitor-induced myocarditis and cardiac metastasis in a cardio-oncology patient presenting with myocardial infarction: A case report. World J Radiol 2025; 17(1): 100794 [DOI: 10.4329/wjr.v17.i1.100794]
Corresponding Author of This Article
George Latsios, MD, PhD, Chief Physician, 1st Department of Cardiology, Athens Medical School, “Hippokration” General Hospital, Alexandroupoleos 9, Athens 11527, Greece. glatsios@gmail.com
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Radiol. Jan 28, 2025; 17(1): 100794 Published online Jan 28, 2025. doi: 10.4329/wjr.v17.i1.100794
Differentiating between immune checkpoint inhibitor-induced myocarditis and cardiac metastasis in a cardio-oncology patient presenting with myocardial infarction: A case report
George Latsios, Yiannis Dimitroglou, George Lazaros, Nikos Alexopoulos, Ilias Tolis, Constantina Aggeli, Costas Tsioufis
George Latsios, Yiannis Dimitroglou, George Lazaros, Ilias Tolis, Constantina Aggeli, Costas Tsioufis, 1st Department of Cardiology, Athens Medical School, “Hippokration” General Hospital, Athens 11527, Greece
Nikos Alexopoulos, Department of Radiology, Athens Euroclinic Hospital, Athens 11526, Greece
Author contributions: Latsios G and Dimitroglou Y drafted the original manuscript; Latsios G, Dimitroglou Y, Lazaros G, Alexopoulos N, and Tolis I contributed to the clinical care of the patient; Aggeli C revised and edited the final manuscript; Tsioufis K had the overall supervision.
Informed consent statement: The patient gave her informed consent in advance.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: George Latsios, MD, PhD, Chief Physician, 1st Department of Cardiology, Athens Medical School, “Hippokration” General Hospital, Alexandroupoleos 9, Athens 11527, Greece. glatsios@gmail.com
Received: August 26, 2024 Revised: December 2, 2024 Accepted: January 9, 2025 Published online: January 28, 2025 Processing time: 147 Days and 18.5 Hours
Abstract
BACKGROUND
Cardiovascular diseases and cancer are leading causes of morbidity and mortality. Patients with malignancies are at increased risk for cardiovascular complications including acute coronary syndromes, chemotherapy or radiation therapy related complications and cardiac metastasis.
CASE SUMMARY
We present a case of a 47-year-old female with metastatic cancer on immunotherapy presented with anterior ST elevation myocardial infarction followed by emergent percutaneous coronary intervention in the left anterior descending artery. Echocardiography after 72 hours showed thickening of inferior wall and cardiac magnetic resonance depicted inflammation and necrosis attributable to either cardiac metastasis or immunotherapy induced myocarditis. Biopsy was not performed because of treatment with antiplatelet drugs and a definite diagnosis was achieved after probationary administration of high-dose intravenous methylprednisolone that led to recovery.
CONCLUSION
In patients with malignancy, chemotherapy-induced cardiovascular complications and cardiac metastasis are common concerns and may coexist with common acute cardiovascular diseases including acute coronary syndromes. In such cases clinical suspicion aided by multimodality imaging is crucial for the diagnosis. A multidisciplinary team approach is required for prompt initiation of the appropriate treatment.
Core Tip: This case report presents a cardio oncology patient who presented with an acute coronary syndrome. However, the clinical presentation as well as the echocardiography findings were suspicious for an alternative diagnosis including immune checkpoint inhibitor-induced myocarditis or cardiac metastasis. Cardiac magnetic resonance aided the final diagnosis and the initiation of the appropriate treatment by the multidisciplinary team. The case highlights the significance of multimodality imaging for the management of cardio-oncology patients.
