Development of Severe Heart Failure in a Patient with Squamous Non-small-cell Lung Cancer During Nivolumab Treatment

Intern Med. 2020 Aug 15;59(16):2003-2008. doi: 10.2169/internalmedicine.4550-20. Epub 2020 May 23.


Cardiac side effects associated with immune checkpoint inhibitors (ICIs) are an uncommon but serious complication with a relatively high mortality. We experienced a case of cardiomyopathy induced by nivolumab. Echocardiography showed diffuse hypo-kinesis of the left ventricular cardiac wall and a significant decrease in the ejection fraction, like dilated cardiomyopathy. The myocardial biopsy showed non-inflammatory change; cardiac function gradually improved after treatment of acute heart failure without a corticosteroid. Although non-inflammatory left ventricular dysfunction induced by ICIs is rare, it is a reported cardiovascular toxicity. Physicians should consider this complication when treating patients with ICIs for malignant diseases.

Keywords: dilated cardiomyopathy; heart failure; immune checkpoint inhibitor; immune-related adverse events; lung cancer; nivolumab.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Antineoplastic Agents / adverse effects*
  • Antineoplastic Agents / therapeutic use
  • Carcinoma, Non-Small-Cell Lung / drug therapy*
  • Echocardiography
  • Heart Failure / chemically induced*
  • Humans
  • Immune Checkpoint Inhibitors / adverse effects*
  • Immune Checkpoint Inhibitors / therapeutic use
  • Lung Neoplasms / drug therapy*
  • Male
  • Nivolumab / adverse effects*
  • Nivolumab / therapeutic use


  • Antineoplastic Agents
  • Immune Checkpoint Inhibitors
  • Nivolumab