{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T20:31:13Z","timestamp":1792528273241,"version":"4.5.0"},"reference-count":11,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2025,2,17]],"date-time":"2025-02-17T00:00:00Z","timestamp":1739750400000},"content-version":"vor","delay-in-days":16,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Immune checkpoint inhibitors (ICIs) are a class of cancer immunotherapy with growing indications for treatment of various malignancies. Immune checkpoint inhibitors are monoclonal antibodies that block inhibitory pathways in immune cells, including cytotoxic T lymphocyte antigen-4 (CTLA4), programmed death 1 receptor (PD1), and programmed cell death ligand-1 (PDL1), to activate the immune system. However, these agents can disrupt self-tolerance and lead to immune-related adverse events. Fulminant myocarditis, a feared complication of ICIs, can be highly fatal, and there is a need for effective treatment options.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>A 70-year-old patient with recurrent metastatic disease of urothelial carcinoma subsequently developed fulminant myocarditis after receiving eight cycles of pembrolizumab. He developed cardiogenic shock and required inotropes and a percutaneous microaxial flow pump placement for temporary mechanical circulatory support. He received methylprednisolone initially and then was started on second-line immunosuppression agents, ruxolitinib and abatacept, for steroid-refractory myocarditis. Abatacept is thought to inhibit activation of T-cell CTLA4 and PD1\/PDL1 pathways and reverse ICI-activated pathways. Ruxolitinib is a Janus kinase inhibitor that impairs immune activation through suppressing cytokine sensing and production and T-cell activation. After these treatments, the patient subsequently clinically improved and his myocarditis resolved.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>This case highlights ICI myocarditis refractory to corticosteroids leading to treatment with second-line immunosuppression. As immunotherapies are increasingly applied to a broader range of cancers, further research is needed to evaluate the optimal treatment strategy for ICI-related myocarditis and other immune-related adverse events.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytaf019","type":"journal-article","created":{"date-parts":[[2025,2,17]],"date-time":"2025-02-17T08:10:06Z","timestamp":1739779806000},"source":"Crossref","is-referenced-by-count":20,"title":["Successful treatment of immune checkpoint inhibitor-associated fulminant myocarditis with abatacept and ruxolitinib: a case report"],"prefix":"10.1093","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6316-071X","authenticated-orcid":false,"given":"Elena","family":"Wadden","sequence":"first","affiliation":[{"name":"Division of Cardiology, University of Washington Medical Center , 1959 NE Pacific Street, Health Sciences Building, Seattle, WA 98195 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carol","family":"Lai","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Straub Medical Center , 888 S King St, Honolulu, HI 96813 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petros","family":"Grivas","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of Washington Medical Center , 1959 NE Pacific Street, Health Sciences Building, Seattle, WA 98195 ,","place":["USA"]},{"name":"Clinical Research Division, Fred Hutchinson Cancer Center , P.O. Box 19024, Seattle, WA 98109 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shailender","family":"Bhatia","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of Washington Medical Center , 1959 NE Pacific Street, Health Sciences Building, Seattle, WA 98195 ,","place":["USA"]},{"name":"Clinical Research Division, Fred Hutchinson Cancer Center , P.O. Box 19024, Seattle, WA 98109 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J","family":"Portuguese","sequence":"additional","affiliation":[{"name":"Clinical Research Division, Fred Hutchinson Cancer Center , P.O. Box 19024, Seattle, WA 98109 ,","place":["USA"]},{"name":"Division of Hematology and Oncology, University of Washington School of Medicine , 825 Eastlake Ave. E, Seattle, WA 98109 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joe-Elie","family":"Salem","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, Sorbonne Universit\u00e9, INSERM, AP-HP, CIC-1901, Piti\u00e9-Salp\u00eatri\u00e8re Hospital , Paris ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javid J","family":"Moslehi","sequence":"additional","affiliation":[{"name":"Section of Cardio-Oncology and Immunology, University of California San Francisco, Smith Cardiovascular Research Building, 535 Mission Bay Blvd. South , San Francisco, CA 94158 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard K","family":"Cheng","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University 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