title: New-onset third-degree atrioventricular block because of autoimmune-induced myositis under treatment with anti-programmed cell death-1 (nivolumab) for metastatic melanoma.
abstract: There has been considerable progress in treating malignant melanoma over the last few years. The immune-checkpoint-inhibitors nivolumab and pembrolizumab have been approved by the Food and Drug Administration in 2014 for the therapy of metastatic melanoma. Anti-programmed cell death-1-blocking antibodies are known to cause immune-related adverse events. Physicians should be aware of common and rare side effects and pay attention to new ones. We therefore report a severe and life-threatening side effect of anti-programmed cell death-1 immunotherapy with nivolumab that has not been previously reported: the development of a third-degree atrioventricular block. After a second infusion with nivolumab, our patient developed a troponin I-positive and autoantibody-positive myositis and a few days later a new-onset third-degree atrioventricular block. This is most likely because of an autoimmune-induced myositis with a cardiac impairment in terms of a myocarditis, which led to an impairment of the conduction of cardiac electrical stimuli.
authors.affiliation: Departments of aDermatology bCardiology, University Hospital Mainz, Johannes Gutenberg - Universität Mainz, Mainz, Germany.
authors.forename: Juliane
authors.initials: J
authors.lastname: Behling
authors.forename: Joachim
authors.initials: J
authors.lastname: Kaes
authors.forename: Thomas
authors.initials: T
authors.lastname: Münzel
authors.forename: Stephan
authors.initials: S
authors.lastname: Grabbe
authors.forename: Carmen
authors.initials: C
authors.lastname: Loquai
mesh_terms: D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D000074322:Antineoplastic Agents, Immunological / Q000009:adverse effects*; D054537:Atrioventricular Block / Q000209:etiology*; D001327:Autoimmune Diseases / Q000139:chemically induced* / Q000150:complications; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D008545:Melanoma / Q000188:drug therapy* / Q000556:secondary; D008875:Middle Aged; D009220:Myositis / Q000139:chemically induced* / Q000150:complications; D000077594:Nivolumab; D014604:Uveal Neoplasms / Q000188:drug therapy* / Q000473:pathology
chemical_list: D000911:Antibodies, Monoclonal; D000074322:Antineoplastic Agents, Immunological; D000077594:Nivolumab