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We describe the challenging case of an 81-year-old woman with persistently high troponin after undergoing immunotherapy with ipilimumab and nivolumab, and histological evidence of amyloid deposition in the myocardium. The patient received immunosuppressive treatments based on the magnitude of troponin changes because myocarditis was clinically suspected. However, histological examination revealed the deposition of transthyretin amyloid fibrils with only minimal T-lymphocyte infiltration and no myocyte necrosis, suggesting transthyretin cardiac amyloidosis rather than ICI myocarditis. This case highlights the importance of assessing other causes of persistently high troponin, and the necessity of incorporating comprehensive histological and immunohistochemical examinations of the endomyocardial biopsy, especially when cardiovascular magnetic resonance imaging is inconclusive.<\/jats:p>","DOI":"10.1002\/ehf2.13915","type":"journal-article","created":{"date-parts":[[2022,3,30]],"date-time":"2022-03-30T07:49:40Z","timestamp":1648626580000},"page":"2027-2031","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Subtle-But-Smouldering Myocardial Injury After Immune Checkpoint Inhibitor Treatment Accompanied by Amyloid Deposits"],"prefix":"10.1093","volume":"9","author":[{"given":"Mizuki","family":"Ida","sequence":"first","affiliation":[{"name":"Department of Cardiology and Nephrology, Mie University Graduate School of Medicine , 174 Edobashi, Tsu, Mie, 5148507 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