ArticleJACC. Case reports2026
Successful Management of Fulminant Immune Checkpoint Inhibitor-Associated Myocarditis Amid Corticosteroid Constraints and Clinical-Biomarker Dissociation.
Article in JACC. Case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundImmune checkpoint inhibitor (ICI)-associated myocarditis is an uncommon but life-threatening complication. Management is particularly challenging when high-dose corticosteroids are contraindicated and in the presence of clinical-biomarker dissociation. CASE SUMMARY: A 69-year-old man presented with cardiogenic shock and ventricular tachycardia 3 weeks after his first dose of pembrolizumab for lung adenocarcinoma. Despite corticosteroid constraints owing to pulmonary tuberculosis and the complexity of clinical decision-making during tapering with rebound troponin T elevation, the patient achieved favorable long-term survival. DISCUSSION: This case demonstrates a successful management strategy for fulminant ICI-associated myocarditis under the dual constraints of limited corticosteroid use and persistent biomarker elevation, offering valuable clinical insights. TAKE-HOME MESSAGES: Rebound elevation of troponin T levels may indicate myocardial remodeling rather than active injury, supporting corticosteroid tapering in clinically stable patients. In patients with ICI-associated myocarditis and contraindications to corticosteroids, early steroid tapering combined with alternative immunosuppressive therapy may still achieve favorable outcomes.
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