Myocarditis-myositis-myasthenia gravis overlap syndrome depending on immune checkpoint inhibitor
Zeynep Ünlütürk1, Ahmet Mağrur Karagülmez2, Barış Hayti2
1Giresun Prof. Dr. A. Ilhan Ozdemir State Hospital, Giresun, Pamukkale, Turkey.
Abstract:
Immune checkpoint inhibitors are breakthrough monoclonal antibodies in cancer therapy developed against mechanisms that suppress the immune response. After the devastating effects of chemotherapy, these specific agents have given hope to cancer patients. However, every drug has side effects itself and these useful drugs have theirs too. In addition to systemic side effects, there are also neurological side effects, the frequency of which is increasing day by day, although they are reported very rarely for now. Here, we present a case that has myositis-myocarditis-myasthenia gravis overlap syndrome. These three syndromes are very rare even to be seen alone, which are detected together. This syndrome with a very high mortality was brought under control in this case, and the fact that nivolumab treatment can be continued makes the case even more interesting. In this article, it is aimed to draw attention to this serious triple complication of immune checkpoint inhibitors and to review the relevant literature on a case basis.
Insights
Immune checkpoint inhibitors (ICIs) can cause rare neurological side effects. This case study details a patient who developed a severe overlap syndrome of myositis, myocarditis, and myasthenia gravis while on nivolumab therapy.
Area of Science:
- Oncology
- Immunology
- Neurology
Background:
- Immune checkpoint inhibitors (ICIs) are revolutionary cancer therapies targeting immune suppression.
- While effective, ICs can cause immune-related adverse events, including rare neurological toxicities.
Observation:
- A patient presented with a rare overlap syndrome of myositis, myocarditis, and myasthenia gravis.
- This severe triad of conditions is exceptionally uncommon, even when occurring individually.
Findings:
- The patient's condition, characterized by this triple syndrome, was successfully managed.
- Remarkably, nivolumab treatment was able to be continued, suggesting potential for managing ICIs in complex cases.
Implications:
- This case highlights the potential for severe neurological complications from ICIs.
- It underscores the importance of recognizing and managing rare ICI-induced syndromes, even when they involve multiple organ systems.
Related Concept Videos
Myasthenia Gravis: Overview and Treatment
These antibodies interfere with the function of the nicotinic receptors in three ways: by binding to the receptor and disrupting acetylcholine binding; by causing cross-linking of receptors which...
Myocarditis III: Medical Management
Myocarditis I: Introduction
Myasthenia Gravis: Diagnostic Tests
The edrophonium test is a diagnostic tool for myasthenia gravis. It involves...
Myocarditis II: Clinical Features and Diagnostic Tests
Myocarditis IV: Nursing Management


