The Terrible Triad of Checkpoint Inhibition: A Case Report of Myasthenia Gravis, Myocarditis, and Myositis Induced by Cemiplimab in a Patient with Metastatic Cutaneous Squamous Cell Carcinoma
Joint Authors
Jeyakumar, Nikeshan
Etchegaray, Mikel
Henry, Jason
Lelenwa, Laura
Zhao, Bihong
Segura, Ana
Buja, L. Maximilian
Source
Issue
Vol. 2020, Issue 2020 (31 Dec. 2020), pp.1-4, 4 p.
Publisher
Hindawi Publishing Corporation
Publication Date
2020-07-04
Country of Publication
Egypt
No. of Pages
4
Main Subjects
Abstract EN
Background.
We report a case of a patient with squamous cell carcinoma (SCC) who developed myasthenia gravis (MG), myositis, and myocarditis after receiving cemiplimab, an anti-PD-1 immune checkpoint inhibitor (ICI).
Case Presentation.
An 86-year-old man with metastatic periocular SCC presented with decreased vision in the left eye, severe fatigue, and lower back and bilateral hip pain 3 weeks after receiving cemiplimab.
Within hours, he developed dysphonia, pharyngeal secretions, and dysphagia, necessitating intubation.
Endomyocardial biopsy revealed active lymphocyte-mediated necrosis consistent with ICI-induced myocarditis.
Anti-striated muscle and anti-acetylcholine receptor antibodies were elevated, consistent with myositis and myasthenia gravis.
Despite plasma exchange therapy, steroids, and intravenous immunoglobulin, he died from cardiac arrest.
Conclusions.
The presence of myasthenia gravis, myocarditis, or myositis should prompt evaluation for all three toxicities as they may represent an overlap syndrome.
The severity of these immunotoxicities highlights the need for clinicians to suspect multiple simultaneous adverse effects of ICIs.
American Psychological Association (APA)
Jeyakumar, Nikeshan& Etchegaray, Mikel& Henry, Jason& Lelenwa, Laura& Zhao, Bihong& Segura, Ana…[et al.]. 2020. The Terrible Triad of Checkpoint Inhibition: A Case Report of Myasthenia Gravis, Myocarditis, and Myositis Induced by Cemiplimab in a Patient with Metastatic Cutaneous Squamous Cell Carcinoma. Case Reports in Immunology،Vol. 2020, no. 2020, pp.1-4.
https://search.emarefa.net/detail/BIM-1148003
Modern Language Association (MLA)
Jeyakumar, Nikeshan…[et al.]. The Terrible Triad of Checkpoint Inhibition: A Case Report of Myasthenia Gravis, Myocarditis, and Myositis Induced by Cemiplimab in a Patient with Metastatic Cutaneous Squamous Cell Carcinoma. Case Reports in Immunology No. 2020 (2020), pp.1-4.
https://search.emarefa.net/detail/BIM-1148003
American Medical Association (AMA)
Jeyakumar, Nikeshan& Etchegaray, Mikel& Henry, Jason& Lelenwa, Laura& Zhao, Bihong& Segura, Ana…[et al.]. The Terrible Triad of Checkpoint Inhibition: A Case Report of Myasthenia Gravis, Myocarditis, and Myositis Induced by Cemiplimab in a Patient with Metastatic Cutaneous Squamous Cell Carcinoma. Case Reports in Immunology. 2020. Vol. 2020, no. 2020, pp.1-4.
https://search.emarefa.net/detail/BIM-1148003
Data Type
Journal Articles
Language
English
Notes
Includes bibliographical references
Record ID
BIM-1148003