A case of fulminant myocarditis associated with pembrolizumab

Immune checkpoint inhibitors （ICIs） have become one of the most important advances in tumor therapy in recent years. With continuous expansion of the indications of ICIs and the introduction of domestic original drugs into clinical practice, ICIs will be applied in more and more tumor patients. However, severe adverse reactions of ICIs have not captivated widespread concerns among clinicians. In this article, we reported 1 case of fulminant myocarditis caused by pembrolizumab for treating postoperative recurrence of liver cancer. The main manifestations of this patient included elevated level of myocardial enzymes, refractory arrhythmia complicated with liver injury and respiratory failure, etc. The patient died even after active treatment. This case hints that early symptoms of ICIs-associated myocarditis are not typical, which can progress in a fulminant pattern. Prompt identification and intervention should be delivered by clinicians.