Case of Immune Checkpoint Inhibitor Induced Myasthenia Gravis.

Autor: Gullapalli M; Internal Medicine - Pediatrics, University of Arkansas for Medical Sciences, Little Rock, USA., Arulprakash N; Vascular Neurology, Johns Hopkins University School of Medicine, Baltimore, USA., Safar M; Hematology and Medical Oncology, University of Arkansas for Medical Sciences, Little Rock, USA., Kocurek E; Medicine, Division of Pulmonary and Critical Care, University of Arkansas for Medical Sciences, Little Rock, USA.
Jazyk: angličtina
Zdroj: Cureus [Cureus] 2024 Apr 20; Vol. 16 (4), pp. e58651. Date of Electronic Publication: 2024 Apr 20 (Print Publication: 2024).
DOI: 10.7759/cureus.58651
Abstrakt: An 85-year-old man was diagnosed with hepatocellular carcinoma (HCC) and was initially treated with transarterial chemoembolization (TACE) and sorafenib. He was then switched to nivolumab and ipilimumab in view of sorafenib intolerance and disease progression. Subsequently, he developed dysphagia and generalized dyspnea culminating in hypercapnic respiratory failure requiring intubation. After an extensive workup, the etiology of his fluctuating respiratory issues was narrowed down to a likely neuromuscular process. Although antibodies to acetylcholine receptors (anti-AChR Ab) were negative, he was treated with high-dose steroids due to clinical concern for Immune Checkpoint Inhibitor (ICI) neurotoxicity. His recovery post immune suppression and absence of recurrence after ICI cessation suggested the possibility of this being an ICI neurotoxicity manifesting with myasthenic symptoms. Incidentally, he also had evidence of aseptic meningitis on cerebrospinal fluid analysis further strengthening this diagnosis. This case illustrates the importance of early recognition of ICI toxicity which will in turn lead to initiating treatments sooner and also decreasing the length of illness.
Competing Interests: The authors have declared that no competing interests exist.
(Copyright © 2024, Gullapalli et al.)
Databáze: MEDLINE