A case report of nivolumab-induced myasthenia gravis and myositis in a metastatic renal cell carcinoma patient

Abstract

We present a 78-year-old male with renal cell carcinoma who developed myasthenia gravis complicated by myositis after nivolumab administration, which was verified by the presence of antibodies against the acetylcholine receptor. The initial symptom was posterior neck pain, and biochemical examination of blood showed elevated levels of hepatic enzymes and creatine phosphokinase. The level of antibody against the acetylcholine receptor increased 4.1-fold. His condition progressed rapidly resulting in respiratory failure 15 days after conservative therapy.

Neuromuscular and cardiac adverse events associated with immune checkpoint inhibitors: pooled analysis of individual cases from multiple institutions and literature

“…In our systematic literature search, 71 full-texts of case reports or case series of patients with solid tumors who manifested neuromuscular or cardiac irAEs were selected, and data from 120 patients were extracted. 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , ...…”

Nivolumab, a Double-Edged Sword: A Case Report of Nivolumab-Induced Myasthenia Gravis

“…Sev-eral cases have been recorded documenting MG development in patients on nivolumab therapy after one or more cycles. The onset and progression remain unclear, and a systematic approach is needed to establish its true incidence [6]. The exact pathogenesis of nivolumab causing MG is not entirely understood yet, but one hypothesis suggests that it promotes antigen-antibody reaction mediated by T lymphocytes or promotes the activation of B lymphocytes by T2 lymphocytes.…”

Immunopathological basis of immune-related adverse events induced by immune checkpoint blockade therapy

“…Myasthenia gravis is extremely rarely associated with polymyositis [87]. However, ICI-related irAE myasthenia gravis is often complicated by polymyositis or myocarditis and lethal cases have even been reported [88][89][90][91]. Although the pathogenesis of myasthenia gravis is mediated by anti-acetylcholine antibodies, anti-Kv1.4 or antititin antibodies targeting myocytes are often identified in patients with this disease [78].…”