High-dose interleukin 2-induced myocarditis: can myocardial damage reversibility be assessed by cardiac MRI?
AffiliationThe Christie NHS Foundation Trust, The University of Manchester, University Hospital of South Manchester, Manchester, UK.
MetadataShow full item record
AbstractHigh-dose interleukin 2 (HD-IL2) is one of the therapeutic options for patients with metastatic renal cell carcinoma. In well-selected patients with favorable clinical and pathologic features, it offers impressive response and potential long-term remission. It also has a place for treatment for metastatic malignant melanoma and in adoptive cell therapy. However, it is known for its intensive course and toxicities. Myocarditis is one of the known complications of this treatment and can pose a diagnostic challenge to treating oncologists because of its nonspecific and similar presentation to acute coronary syndrome (ACS). We report 3 short cases of HD-IL2-related myocarditis, which were either missed or misdiagnosed as ACS using conventional assessment but subsequently accurately diagnosed by cardiac magnetic resonant imaging (CMR). We discussed the clinical presentation of these cases and demonstrated the diagnostic advantage of CMR compared with standard investigations including its superior capability to assess myocardial reversibility, which has important short-term and long-term implications. The use of CMR also avoided unnecessary invasive intervention such as coronary angiogram in all 3 patients. These example cases call for effort to conduct prospective research to assess and confirm the utility of CMR, thus informing a more effective management pathway for immune-related myocarditis in HD-IL2 and other cancer immunotherapy.
CitationHigh-dose interleukin 2-induced myocarditis: can myocardial damage reversibility be assessed by cardiac MRI? 2014, 37 (5):304-8 J Immunother
JournalJournal of Immunotherapy
- Diagnostic contribution of cardiac magnetic resonance in patients with acute coronary syndrome and culprit-free angiograms.
- Authors: Kawecki D, Morawiec B, Monney P, Pellaton C, Wojciechowska C, Jojko J, Basiak M, Przywara-Chowaniec B, Fournier S, Nowalany-Kozielska E, Schwitter J, Muller O
- Issue date: 2015 Jan 14
- Acute myocarditis presenting as acute coronary syndrome: role of early cardiac magnetic resonance in its diagnosis.
- Authors: Monney PA, Sekhri N, Burchell T, Knight C, Davies C, Deaner A, Sheaf M, Baithun S, Petersen S, Wragg A, Jain A, Westwood M, Mills P, Mathur A, Mohiddin SA
- Issue date: 2011 Aug
- Evolution of acute coronary syndrome with normal coronary arteries and normal cardiac magnetic resonance imaging.
- Authors: Chopard R, Jehl J, Dutheil J, Genon VD, Seronde MF, Kastler B, Schiele F, Meneveau N
- Issue date: 2011 Oct
- The diagnostic role of cardiac magnetic resonance imaging in detecting myocardial inflammation in systemic lupus erythematosus. Differentiation from viral myocarditis.
- Authors: Mavrogeni S, Bratis K, Markussis V, Spargias C, Papadopoulou E, Papamentzelopoulos S, Constadoulakis P, Matsoukas E, Kyrou L, Kolovou G
- Issue date: 2013 Jan
- Diagnosis and management of patients with acute cardiac symptoms, troponin elevation and culprit-free angiograms.
- Authors: Gallagher S, Jones DA, Anand V, Mohiddin S
- Issue date: 2012 Jul