PMC8714936_01
Multiple organ injuries characterized by myocarditis and myositis. (A) Electrocardiogram at admission. (B) Normal and (C) contrast-enhanced imaging in CMR; the white arrow indicated ventricular myocardium LGE. (D) CK-MB, (E) Hs-TnI, (F) CK, (G) ALT and AST, and (H) sCr and eGFR variation curves during glucocorticoid therapy. The black arrow indicated the time we modulated the dosage of methylprednisolone from 0.5 mg/kg/day to 1.5 mg/kg/day.
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Electrocardiogram (ECG) showed new-onset complete right bundle branch block (CRBBB), atrioventricular block, and intermittent junctional escape rhythm ( Figure 1A ). Cardiovascular magnetic resonance (CMR) imaging ( Figures 1B, C ) revealed slight multiple segmental myocardium edema and ventricular septum myocardium late gadolinium enhancement (LGE). However, multiple organ injury-related laboratory indices rapidly rose again ( Figures 1D-H ).
The diagnosis and therapeutic process of the patient. GS, glucose solution; NS, normal saline; Co-Q, coenzyme Q; IVIG, intravenous immunoglobulin. Evaluation of the grade of irAEs is based on NCCN guidelines insights: management of immunotherapy-related toxicities, version 1.2020 and Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immune checkpoint inhibitor-related adverse events..
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Time axis of diagnosis and therapy of the patient is shown in  Figure 2 .
Clinical data of the patient in 1-year follow-up. (A) Laboratory indexes involve myocardial zymogram as well as liver and kidney functions. (B) Cardiac structure and function evaluation in echocardiogram. (C) Electrocardiogram shows CRBBB.
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No active myocardial or skeletal muscle damage existed according to the laboratory indexes ( Figure 3 ).