Camrelizumab-Related Lethal Arrhythmias and Myasthenic Crisis in a Patient with Metastatic Thymoma
Table 3
Timeline.
18 days prior to admission
Patient diagnosed with type B2 thymoma with pleural and left paranephros metastases at her local hospital, treated with thoracic pleural drainage
11 days prior to admission
First dose of intravenous camrelizumab administered
On admission
Symptoms of dyspnea, fatigue, and poor appetite New-onset left anterior fascicular branch block Elevated CK, CK-MB, TnI, ALT, and AST
Day 2 of hospitalization
Bifascicular branch block Diagnosed with ICI-related myocarditis, myositis, and hepatitis Intravenous methylprednisolone (80 mg/day) Intravenous piperacillin/tazobactam (4.5 g three times daily) Intravenous polyene phosphatidylcholine (465 mg/day) Intravenous reduced glutathione (1.8 g/day) Intravenous glucose, potassium, and magnesium supplements
Day 3 of hospitalization
Intermittent second-degree atrioventricular block and ST segment elevation and poor R-wave progression in precordial leads Coronary angiography confirming normal anatomy of coronary artery
Day 4 of hospitalization
Coma due to respiratory muscle paralysis Mechanical ventilation and higher dose of methylprednisolone (1 g/day) plus IVIG (20 g/day) applied Third degree atrioventricular block Urgent temporary pacemaker placed Ventricular tachycardia Direct current defibrillation and multiple antiarrhythmic drugs used
Day 5 of hospitalization
Ventricular fibrillation followed by cardiac arrest, and finally died
