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Case Report ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Cardiovasc. Med. | doi: 10.3389/fcvm.2019.00124

Non-canonical expression of cardiac troponin-T in neuroendocrine ethmoid sinus carcinoma following immune checkpoint blockade

  • 1Faculty of Medicine, University of Miyazaki, Japan
  • 2Miyazaki Prefectural Nobeoka Hospital, Japan

We describe the case of a patient with neuroendocrine ethmoid sinus carcinoma, who exhibited markedly elevated levels of serum cardiac troponin-T and creatine kinase (CK)-MB isoenzyme without any symptom after the administration of nivolumab, immune checkpoint inhibitor. The repeated 12-leads-electrocardiogram did not show any changes in the ST-T segments or arrhythmias. The echocardiogram showed normal ranges of left ventricular contraction in the clinical course. Cardiac magnetic resonance imaging showed minimal myocardial edema and inflammation. Blood clots in the metastatic lesion of bone marrow aspirates exhibited positive staining for cardiac troponin-T and CK-MB in the cytoplasm and nucleoplasm of neoplastic cells. Although we did not perform a second cardiac magnetic resonance imaging and autopsy, we postulate that the attack of the neoplastic cells by the immune checkpoint inhibitor or the secretion from neoplastic cell-derived extracellular vesicles may have exacerbated the increase in concentrations of these molecules in the blood. Our case should warrant consideration a false-positive value of cardiac troponin-T and CK-MB can be obtained in cases with malignancy.

Keywords: Troponin, Creatine Kinase, MRI, Echocardiogram, neuroendocrine tumor

Received: 21 Jun 2019; Accepted: 12 Aug 2019.

Edited by:

Carlo G. Tocchetti, University of Naples Federico II, Italy

Reviewed by:

Gilda Varricchi, Department of Translational Medical Sciences, University of Naples Federico II, Italy
Christian Cadeddu Dessalvi, University of Cagliari, Italy
Valentina Mercurio, University of Naples Federico II, Italy  

Copyright: © 2019 Tsuruda, Sato, Kajihara, Kawabata, Kubuki, Komaki, Kikuchi, Ishikawa, Tono and Kitamura. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Toshihiro Tsuruda, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan, ttsuruda@med.miyazaki-u.ac.jp