Immune Checkpoint Inhibitor-Mediated Myasthenia Gravis.
immune checkpoint inhibitors
myasthenia gravis
toxicity
Journal
The Journal of emergency medicine
ISSN: 0736-4679
Titre abrégé: J Emerg Med
Pays: United States
ID NLM: 8412174
Informations de publication
Date de publication:
Oct 2020
Oct 2020
Historique:
received:
04
02
2020
revised:
02
05
2020
accepted:
04
05
2020
pubmed:
23
6
2020
medline:
24
6
2021
entrez:
23
6
2020
Statut:
ppublish
Résumé
Immune checkpoint inhibitors (ICIs) have a wide range of toxicities affecting potentially any organ system stemming from increased activity within the T-cell lineage similar to that observed in autoimmunity. A 57-year-old man with metastatic papillary renal cell carcinoma treatment with combination ICI therapy presented with a history of rapidly progressive diplopia. Neurological examination revealed bilateral fatigable ptosis and asymmetrical ophthalmoplegia. His clinical findings were in keeping with an immune-mediated myasthenia gravis. He was immediately commenced on 1 mg/kg of intravenous methylprednisolone and pyridostigmine 60 mg 3 times a day. On day 2 of admission he was given 1 g/kg of intravenous immunoglobulins. He made a rapid and full clinical recovery. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Immune-mediated myasthenia gravis is an important toxicity of ICIs. Early recognition and treatment of this presentation may reduce the significant morbidity and mortality associated with it.
Sections du résumé
BACKGROUND
BACKGROUND
Immune checkpoint inhibitors (ICIs) have a wide range of toxicities affecting potentially any organ system stemming from increased activity within the T-cell lineage similar to that observed in autoimmunity.
CASE REPORT
METHODS
A 57-year-old man with metastatic papillary renal cell carcinoma treatment with combination ICI therapy presented with a history of rapidly progressive diplopia. Neurological examination revealed bilateral fatigable ptosis and asymmetrical ophthalmoplegia. His clinical findings were in keeping with an immune-mediated myasthenia gravis. He was immediately commenced on 1 mg/kg of intravenous methylprednisolone and pyridostigmine 60 mg 3 times a day. On day 2 of admission he was given 1 g/kg of intravenous immunoglobulins. He made a rapid and full clinical recovery. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Immune-mediated myasthenia gravis is an important toxicity of ICIs. Early recognition and treatment of this presentation may reduce the significant morbidity and mortality associated with it.
Identifiants
pubmed: 32565169
pii: S0736-4679(20)30402-9
doi: 10.1016/j.jemermed.2020.05.004
pii:
doi:
Substances chimiques
Immune Checkpoint Inhibitors
0
Immunoglobulins, Intravenous
0
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
561-562Informations de copyright
Crown Copyright © 2020. Published by Elsevier Inc. All rights reserved.