The Drug-Induced Respiratory Disease Website

Pembrolizumab

Myocarditis (can be fulminate/fulminant)

Can be fatal

Publications

Portolés Hernández A, Blanco Clemente M, Escribano García D, Velasco Calvo R, Núñez García B, Oteo Domínguez JF, Salas Antón C, Méndez García M, Segovia Cubero J, Domínguez F

Checkpoint inhibitor-induced fulminant myocarditis, complete atrioventricular block and myasthenia gravis-a case report.

Cardiovascular diagnosis and therapy 2021 Aug;11;1013-1019 — 2021 Aug — 1013-1019

Inayat F, Masab M, Gupta S, Ullah W

New drugs and new toxicities: pembrolizumab-induced myocarditis.

BMJ case reports 2018 Jan 23;2018; — 2018 Jan 23

Läubli H, Balmelli C, Bossard M, Pfister O, Glatz K, Zippelius A

Acute heart failure due to autoimmune myocarditis under pembrolizumab treatment for metastatic melanoma.

Journal for immunotherapy of cancer 2015;3;11 — 2015 — 11

Diagnosing DIRD

Drug and radiation history

Drug singularity - Correct identification of the drug

Consistent timing of exposure v. onset of symptoms

Clinical, imaging, BAL, pathological pattern consistent with the specific drug

Careful exlusion of another cause

Remission of symptoms with removal of drug

Recurrence with rechallenge (rarely advisable)

Causality assessment

Diagnosing DIRD

Identify causative drugs

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