Multiple Immunotherapy-Related Cardiovascular Sequelae

Use of immune checkpoint inhibitors (ICIs) is a revolutionary therapy, but it is associated with immune-related adverse events (irAEs). An elderly woman with xanthogranuloma disseminatum (XD) presented with constitutional symptoms and an elevated troponin level after receiving pembrolizumab, an ICI associated with relatively rare cardiovascular adverse events. The patient was determined to have acute coronary syndrome, as well as new onset atrial fibrillation and thyrotoxicosis. We propose that all 3 conditions represent concurrent irAEs related to use of pembrolizumab. This case stresses the importance of considering ICI-related toxicity for patients with multiple events.