Ipilimumab-nivolumab therapy causing STEMI in a melanoma patient: A case report

The combination of ipilimumab and nivolumab has shown great promise in improving survival in patients with advanced melanoma. However, these novel agents are not without side effects, with adverse events occurring in up to 55% of patients on combination therapy. We report a case of ST-elevation myocardial infarction (STEMI) with resultant new severe systolic heart failure and left ventricular thrombus in a middle-aged woman with metastatic melanoma on ipilimumab-nivolumab therapy suspicious for de novo intra-arterial thrombus formation. We hypothesize that this is likely due to an immune-related adverse event, a documented phenomenon in patients on this combination therapy. To the best of our knowledge, this is the first case in patients on ipilimumab-nivolumab therapy to develop STEMI due to intra-arterial thrombus formation.