Severe acute myositis and myocarditis upon initiation of six-weekly Pembrolizumab post-COVID-19 mRNA vaccination
Watson, R. A.; Ye, W.; Taylor, C. A.; Cooper, R. A.; Tong, O.; James, T.; Shine, B.; Hofer, M.; Jenkins, D.; Pell, R.; Ieremia, E.; Jones, S.; Maldonado-Perez, D.; Roberts, I.; Coupe, N.; Middleton, M. R.; Payne, M. J.; Fairfax, B. P.
Show abstract
We describe three cases of critical acute myositis with myocarditis occurring within 22 days of each other at a single institution, all within one month of receiving the initial cycle of the anti-PD-1 drug Pembrolizumab. Analysis of T cell receptor repertoires from peripheral blood and tissues revealed a high degree of clonal expansion and public clones between cases, with several T cell clones expanded within the skeletal muscle putatively recognising viral epitopes. All patients had recently received a COVID-19 mRNA booster vaccine prior to treatment and were positive for SARS-CoV2 Spike antibody. In conclusion, we report a series of unusually severe myositis and myocarditis following PD-1 blockade and the COVID-19 mRNA vaccination.
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