AUTHOR=Xie Xiaohong , Wang Fei , Qin Yinyin , Lin Xinqing , Xie Zhanhong , Liu Ming , Ouyang Ming , Luo Bihui , Gu Yingying , Li Shiyue , Gu Dejian , Chen Rongrong , Zhou Chengzhi 

TITLE=Case Report: Fatal Multiorgan Failure and Heterochronous Pneumonitis Following Pembrolizumab Treatment in a Patient With Large-Cell Neuroendocrine Carcinoma of Lung

JOURNAL=Frontiers in Pharmacology

VOLUME=Volume 11 - 2020

YEAR=2021

URL=https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2020.569466

DOI=10.3389/fphar.2020.569466

ISSN=1663-9812

ABSTRACT=Immune checkpoint inhibitor is an effective tumor therapy that has been introduced for the therapy of many cancers and severe immune-related adverse events are reported and relatively common. However, lethal simultaneous multi-organ failure has rare reported. 
Here, we described a patient who developed multi-organ failure including fulminant myocarditis, myasthenia gravis crisis, hepatic dysfunction and delayed pneumonitis after undergoing pembrolizumab therapy for lung large cell neuroendocrine carcinoma. In the treatment of this patient, we found that the implantation of cardiac pacemaker combined with high-dose steroids may be a feasible method to rescue myocarditis caused by immune checkpoint inhibitor. 
Consideration of delayed pneumonitis found after myocarditis in our patient, heterochronous adverse events should be notice.