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We describe three cases of critical acute myositis with myocarditis occurring within 22 days of each other at a single institution, all within 1 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 recognizing 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.

Original publication




Journal article


J Immunother Cancer

Publication Date





Case Reports, Immune Checkpoint Inhibitors, Melanoma, Receptors, Antigen, T-Lymphocytes, Humans, Myocarditis, Antibodies, Monoclonal, Humanized, Myositis, COVID-19, Male, SARS-CoV-2, Female, Middle Aged, Aged, COVID-19 Vaccines, Immune Checkpoint Inhibitors, Vaccination