{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T23:18:22Z","timestamp":1790983102639,"version":"4.1.0"},"reference-count":17,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"content-version":"vor","delay-in-days":217,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Case Reports in Cardiology"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Immune checkpoint inhibitors (ICIs) such as durvalumab improve survival in solid tumors but can rarely cause fulminant myocarditis (reported in 1% of cases, with 25%\u201340% mortality). Clinical overlap with coronary artery disease (CAD), chemotherapy\u2010related cardiomyopathy, or malignancy\u2010associated complications makes diagnosis challenging.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>A 62\u2010year\u2010old woman with gallbladder adenocarcinoma on gemcitabine, cisplatin, and durvalumab presented with 1 week of progressive dyspnea, leg edema, and chest pain. She had a history of portal vein thrombosis on apixaban. On exam, she was tachycardic and hypoxic with signs of volume overload. Labs showed elevated BNP and troponin. EKG revealed lateral T\u2010wave inversions and chest x\u2010ray demonstrated pulmonary edema. Echocardiography showed a large fibrinous pericardial effusion without tamponade and reduced LVEF (41%) with apical wall motion abnormalities. Differentials included ischemia, chemotherapy toxicity, ICI myocarditis, or malignant\/hemorrhagic effusion. After a multidisciplinary discussion, anticoagulation was held, and the patient was transfused. Serial echocardiography showed a stable effusion but persistent ST\u2010T changes. Coronary angiography excluded obstructive CAD. Cardiac MRI demonstrated diffuse myocardial edema, most pronounced in apical segments, consistent with myocarditis. Given the temporal relationship to ICI therapy, durvalumab\u2010associated myocarditis was diagnosed. High\u2010dose corticosteroids were initiated with symptomatic improvement. She was discharged on gemcitabine\u2013cisplatin, with durvalumab omitted. Anticoagulation was resumed. Discharge echocardiography showed persistent apical wall motion abnormalities with a small effusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case highlights the diagnostic complexity of dyspnea in oncology patients, where multiple cardiac pathologies may coexist. A systematic, multidisciplinary approach\u2014progressing from pericardial evaluation to ischemic work\u2010up to advanced imaging\u2014was crucial for diagnosis. Clinicians should maintain suspicion for ICI myocarditis when new heart failure or wall motion abnormalities occur without obstructive CAD, as early immunosuppressive therapy is critical.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/cric\/9654777","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T08:56:18Z","timestamp":1786006578000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Dyspnea Dilemma: Immune Checkpoint Inhibitor\u2013Associated Myocarditis Mimicking Overlapping Cardiac Pathologies\u2014A Case 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