10 years prior to presentation	Patient diagnosed with thymic carcinoma; treated with four cycles cisplatin/etoposide
5 years prior to presentation	Presents with recurrent disease to bone and pleura; treated with sunitinib (discontinued after 1 year)
1 year prior to presentation	Progressive disease of spine; undergoes decompressive laminectomy (levels T7–T8)
16 days prior to presentation	New metastases discovered in bone and lung; treated with pembrolizumab (one cycle)
Upon first emergent presentation	Left lower lobe pulmonary embolism discovered; treated with enoxaparin (subcutaneous)
2 days following first emergent presentation	Discharged to home
Upon second emergent presentation (5 days following first emergent presentation)	Presents with acute illness, right bundle branch block with elevated troponin, ST elevation in precordial leads, myocarditis suspected. Treated with methylprednisolone (IV); enoxaparin (subcutaneous); aspirin (oral)
Day 1 to Day 28 following second emergent presentation	Patient with complete heart block received dual-chamber pacemaker, coronary artery disease ruled out by negative cardiac catheterization, immune checkpoint inhibitor myocarditis confirmed by endomyocardial biopsy: pulse-dose methylprednisolone IV, followed by oral prednisone
Day 29 to Day 50 following second emergent presentation	Patient exhibits hypercapnia and respiratory failure; positive antibodies, physical findings significant for myasthenia gravis. Patient receives intubation [with eventual extubation to bilevel positive airway pressure (BiPAP)]; pyridostigmine; plasmapheresis; methylprednisolone (IV); and prednisone (oral)
Day 50 following second emergent presentation	Discharge to home with BiPAP treatment during sleep
6 weeks following administration of pembrolizumab	Computed tomography results showed improvement of disease with significant decrease or resolution of all measurable sites of metastatic disease in the lungs