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Nivolumab-Induced Third Degree Atrioventricular Block in a Patient with Stage IV Squamous Cell Lung Carcinoma
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A6939 - Nivolumab-Induced Third Degree Atrioventricular Block in a Patient with Stage IV Squamous Cell Lung Carcinoma
Author Block: H. Mezughi1, H. Bukamur2, E. Karem1, E. Alkhankan2, I. Shahoub2, Y. R. Shweihat2; 1Internal Medicine, Marshall University Internal Medicine Program, Huntington, WV, United States, 2Pulmonary Medicine, Marshall University, Huntington, WV, United States.
Nivolumab is a fully human, IgG4 immune checkpoint inhibitor antibody that binds Phosphodiesterase-1 on activated immune cells to disrupt PD-1 interaction with PD-L1 and PD-L2 ligands, thereby attenuating inhibitory signals and augmenting the host anti-tumor response. Nivolumab is often used in treatment of non-small-cell lung cancer with clinical survival benefits. Treatment with anti-PD-1 agents can be lead to devastating immune-related adverse events including autoimmune myositis. When myocarditis occur, it can involve the electrical conduction system in the heart and therefor may lead to bradycardia and heart blocks.
We present a 88-year-old female with past medical history of hypertension, hyperlipidemia and systemic lupus erythematosus who had been treated with prednisone for about 30 years on daily bases. She was recently diagnosed with stage IV squamous cell lung cancer that was initially treated with Paclitaxel with poor tolerance due to side effects. She was started on Nivolumab 240mg every 2 weeks for 2 cycles of Nivolumab. Patient developed a proximal muscle weakness and was admitted to the hospital afterwards. Her total creatine kinase level was found to be 4050, with a myoglobin of 5373 and a troponin of 2220, Her serum acetylcholine binding antibody was negative. The patient was started on a high-dose pulse steroids and pyridostigmine as she was suspected to have myasthenia gravis with out any improvement. During her hospital stay she developed sinus bradycardia that progressed to complete atrioventricular block. Electrophysiology cardiology was consulted and a temporary pacemaker was inserted with a permanent pacemaker placement eventually.
Author Block: H. Mezughi1, H. Bukamur2, E. Karem1, E. Alkhankan2, I. Shahoub2, Y. R. Shweihat2; 1Internal Medicine, Marshall University Internal Medicine Program, Huntington, WV, United States, 2Pulmonary Medicine, Marshall University, Huntington, WV, United States.
Nivolumab is a fully human, IgG4 immune checkpoint inhibitor antibody that binds Phosphodiesterase-1 on activated immune cells to disrupt PD-1 interaction with PD-L1 and PD-L2 ligands, thereby attenuating inhibitory signals and augmenting the host anti-tumor response. Nivolumab is often used in treatment of non-small-cell lung cancer with clinical survival benefits. Treatment with anti-PD-1 agents can be lead to devastating immune-related adverse events including autoimmune myositis. When myocarditis occur, it can involve the electrical conduction system in the heart and therefor may lead to bradycardia and heart blocks.
We present a 88-year-old female with past medical history of hypertension, hyperlipidemia and systemic lupus erythematosus who had been treated with prednisone for about 30 years on daily bases. She was recently diagnosed with stage IV squamous cell lung cancer that was initially treated with Paclitaxel with poor tolerance due to side effects. She was started on Nivolumab 240mg every 2 weeks for 2 cycles of Nivolumab. Patient developed a proximal muscle weakness and was admitted to the hospital afterwards. Her total creatine kinase level was found to be 4050, with a myoglobin of 5373 and a troponin of 2220, Her serum acetylcholine binding antibody was negative. The patient was started on a high-dose pulse steroids and pyridostigmine as she was suspected to have myasthenia gravis with out any improvement. During her hospital stay she developed sinus bradycardia that progressed to complete atrioventricular block. Electrophysiology cardiology was consulted and a temporary pacemaker was inserted with a permanent pacemaker placement eventually.
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