一名65岁女性因胸痛和呼吸困难就诊。六个月前，患者下背部、左脊柱旁肌肉和右胁腹急性疼痛为期四天。她被诊断为KRAS阳性肺腺癌，癌症已从肺转移到纵隔、椎骨和肋骨。不久，开始靶向化疗。病情进展后，改为纳武单抗（PD1免疫检查点抑制剂）。三周后，患者背痛、呼吸困难加重；两天后，左侧胸壁新发刺痛，TnT、D-dimer和白细胞计数升高，入住心内科。患者TnT升高可能与癌症治疗有关。免疫系统的激活可能引起免疫相关性不良事件（如心肌炎），尽管发生率很低。心肌炎解释了所有症状体征，及非缺血性心脏病时TnT的升高。与免疫检查点抑制剂治疗相关的心肌炎发生率在0.06％至1.1％之间，临床表现从无症状TnT升高到心源性猝死。
A65-year-oldwomanpresentedwithchestpainanddyspnea.Sixmonthsearlier,thepatientpresentedwitha4-dayhistoryofacutepaininthelowerback,leftparaspinalmuscles,andrightflank.ShereceivedthediagnosisofKRASpositivelungadenocarcinomathathadmetastasizedfromthelungtothemediastinum,vertebrae,andribs.Shortlyaftershereceivedthediagnosis,shebeganchemotherapy.Afterdiseaseprogression,hertreatmentwasshiftedtonivolumab(aPD1theimmunecheckpointinhibitor).Threeweekslater,herbackpainanddyspneahadworsened.Twodayslater,thepatientpresentedwithanewstabbingpainintheleftlateralchestwall.ThetroponinTlevel,d-dimerlevel,andwhitecellscountareelevated.Shewasadmittedtothecardiologyunite.Onepossibleexplanationtoaccountforthispatient’selevatedtroponinTlevelwasthetreatmentshereceivedtocontrolhercancer.Activationoftheimmunesystemmaybeassociatedwithanimmune-relatedadverseeventsuchasmyocarditis,althoughthiseventisun
