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Case Reports
. 2022 Nov 8;15(3):967-973.
doi: 10.1159/000526534. eCollection 2022 Sep-Dec.

Transthyretin Cardiac Amyloidosis Mimicking Immune Checkpoint-Induced Myocarditis in a Patient Treated with Atezolizumab and Bevacizumab for Advanced Hepatocellular Carcinoma: A Case Report

Pierrine Le Bras  1 , Louise Plard  2 , Christèle Le Gouill  3 , Nicolas Piriou  2 , Yann Touchefeu  1   3
Affiliations
Case Reports

Transthyretin Cardiac Amyloidosis Mimicking Immune Checkpoint-Induced Myocarditis in a Patient Treated with Atezolizumab and Bevacizumab for Advanced Hepatocellular Carcinoma: A Case Report

Pierrine Le Bras et al. Case Rep Oncol. .

Abstract

Checkpoint kinase inhibitors are increasingly used in oncology. The combination of atezolizumab and bevacizumab is currently the recommended first-line treatment for advanced hepatocellular carcinoma. Cardiac toxicities of immunotherapies are rare, but can lead to discontinuation of treatment. Transthyretin cardiac amyloidosis is a rare condition, but its incidence is probably underestimated. Its symptoms may suggest immunotherapy-induced myocarditis. When immune-mediated myocarditis is suspected, a thorough cardiac evaluation is necessary to confirm or refute the diagnosis of myocarditis and to avoid unnecessary interruption of immunotherapy. Cardiac magnetic resonance imaging may raise suspicion of transthyretin cardiac amyloidosis, the diagnosis being confirmed by technetium pyrophosphate bone scintigraphy.

Keywords: Checkpoint-kinase inhibitor; Immunotherapy; Myocarditis; Transthyretin cardiac amyloidosis.

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Conflict of interest statement

None of the authors declared conflicts of interest.

Figures

Fig. 1
Fig. 1
Timeline with the main events of the case report.
Fig. 2
Fig. 2
Late gadolinium enhancement (LGE) sequence, short axis view of right and left ventricles. The arrow indicates midwall LGE of the anterior and lateral walls of the left ventricle, a feature suggestive of myocarditis in the context of suspected immune checkpoint inhibitor-induced myocarditis. However, associated extensive LGE of the right ventricle was atypical and suggestive of an infiltrative myocardial disease such as cardiac amyloidosis.
Fig. 3
Fig. 3
99mTc-hydroxymethylene diphosphonate (99mTc-HDP) bone scintigraphy, Perugini grade III cardiac uptake. L = Left; R = Right.
See this image and copyright information in PMC

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