Atezolizumab-induced myositis and myocarditis in a patient with metastatic urothelial carcinoma

BMJ Case Rep. 2020 Dec 9;13(12):e236357. doi: 10.1136/bcr-2020-236357.

Abstract

Immune checkpoint inhibitors have revolutionised cancer therapy in the past decade. Although they have been indicated to treat a diverse range of malignant neoplasms, they are also associated with various immune-related adverse effects. We report the case of a 74-year-old man with a history of urothelial carcinoma who had atezolizumab-induced myocarditis and myositis resulting in acute hypercapnic respiratory failure, despite the discontinuation of atezolizumab and aggressive treatment with corticosteroids. This case highlights the importance of a multidisciplinary approach for early diagnosis and treatment of immune-related adverse events. Physicians must be aware of the risks associated with immune checkpoint inhibitors and have a basic knowledge regarding their management.

Keywords: adult intensive care; haematology (drugs and medicines); immunological products and vaccines; unwanted effects / adverse reactions; urological cancer.

Publication types

  • Case Reports

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Aged
  • Antibodies, Monoclonal, Humanized / administration & dosage
  • Antibodies, Monoclonal, Humanized / adverse effects*
  • Antineoplastic Agents, Immunological / adverse effects*
  • Humans
  • Lung Neoplasms / secondary
  • Lung Neoplasms / therapy
  • Male
  • Myocarditis / chemically induced*
  • Myocarditis / drug therapy
  • Myositis / chemically induced*
  • Myositis / drug therapy
  • Urologic Neoplasms / pathology
  • Urologic Neoplasms / therapy

Substances

  • Adrenal Cortex Hormones
  • Antibodies, Monoclonal, Humanized
  • Antineoplastic Agents, Immunological
  • atezolizumab