2025 Volume 66 Issue 11 Pages 491-500
An 80-year-old man on maintenance dialysis with a history of two surgeries for hepatocellular carcinoma developed recurrence in the right hepatic lobe and segment 3 and was started on atezolizumab plus bevacizumab (ATZ+BV). Persistent fever developed a few days following treatment, necessitating hospitalization on day 18. On day 22, CPK and troponin levels were elevated without muscle or chest pain. On day 24, he developed altered consciousness, followed by generalized seizures on day 25. Suspecting immune-related myocarditis and encephalitis, we initiated steroid pulse therapy. On day 27, he developed atrioventricular block requiring pacemaker insertion, followed by respiratory failure requiring intubation. After temporary improvement and extubation, status epilepticus recurred on day 41, requiring reintubation. On the same day, anti-amphiphysin antibodies were detected. He died of septic shock on day 44. This case suggests that ATZ+BV might have triggered the myocarditis and paraneoplastic neurological syndrome.
