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Their underlying mechanisms remain incompletely understood, although autoimmune predisposition and cross-antigen responses have been implicated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>We report the case of a young, immunologically predisposed patient with renal cell carcinoma who developed recurrent episodes of myocardial injury following an initial mild ICI-related myocarditis. Subsequent viral infections acted as triggers for repeated myocardial damage despite discontinuation of ICI therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Novel immune biomarkers were identified, and distinctive findings on endomyocardial biopsy, together with tumour protein expression patterns, provided insight into the patient\u2019s heightened myocardial immune vulnerability to viral infections. This case highlights the complex interplay between ICI therapy, host immune predisposition, and viral triggers in the pathogenesis of cardiac irAEs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytag579","type":"journal-article","created":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T12:07:47Z","timestamp":1785586067000},"source":"Crossref","is-referenced-by-count":1,"title":["Myocardial immune vulnerability unmasked after treatment with immune checkpoint inhibitors: a case report"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4384-935X","authenticated-orcid":false,"given":"Eduardo","family":"Zatarain-Nicol\u00e1s","sequence":"first","affiliation":[{"name":"Cardiology Department, Gregorio Mara\u00f1\u00f3n University Hospital, IISGM, Complutense University , Calle Doctor Esquerdo 46, Madrid 28007 ,","place":["Spain"]},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red Enfermedades Cardiovasculares (CIBER-CV), Instituto de Salud Carlos III (ISCIII) , Calle Monforte de Lemos, 3-5, Pabell\u00f3n 11, Planta baja, Madrid 28029 ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8556-753X","authenticated-orcid":false,"given":"Laura","family":"Yousif","sequence":"additional","affiliation":[{"name":"Cardiovascular Institute, Thorax Center, Department of Cardiology, Erasmus University Medical Center , Dr. Molewaterplein, Rotterdam 403015 GD ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5090-8488","authenticated-orcid":false,"given":"Francisco","family":"Diaz-Crespo","sequence":"additional","affiliation":[{"name":"Pathology Department, Gregorio Mara\u00f1\u00f3n University Hospital , Calle Doctor Esquerdo 46, Madrid 28007 ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1489-9294","authenticated-orcid":false,"given":"Enrique","family":"Ortega-Sollero","sequence":"additional","affiliation":[{"name":"Centro Nacional de Investigaciones Cardiovasculares (CNIC) , Calle Melchor Fern\u00e1ndez Almagro 3, Madrid 28029 ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0009-2147","authenticated-orcid":false,"given":"Jos\u00e9 \u00c1ngel","family":"Arranz","sequence":"additional","affiliation":[{"name":"Oncology Department, Gregorio Mara\u00f1\u00f3n University Hospital , Calle de Maiquez 7, Madrid 28009 ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5241-2758","authenticated-orcid":false,"given":"Javier","family":"Bermejo","sequence":"additional","affiliation":[{"name":"Cardiology Department, Gregorio Mara\u00f1\u00f3n University Hospital, IISGM, Complutense University , Calle Doctor Esquerdo 46, Madrid 28007 ,","place":["Spain"]},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red Enfermedades Cardiovasculares (CIBER-CV), Instituto de Salud Carlos III (ISCIII) , Calle Monforte de Lemos, 3-5, Pabell\u00f3n 11, Planta baja, Madrid 28029 ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2392-1764","authenticated-orcid":false,"given":"Pilar","family":"Mart\u00edn","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red Enfermedades Cardiovasculares (CIBER-CV), Instituto de Salud Carlos III (ISCIII) , Calle Monforte de Lemos, 3-5, Pabell\u00f3n 11, Planta baja, Madrid 28029 ,","place":["Spain"]},{"name":"Centro Nacional de Investigaciones Cardiovasculares (CNIC) , Calle Melchor Fern\u00e1ndez Almagro 3, Madrid 28029 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