Acetylcholine receptor binding antibody-associated myasthenia gravis and rhabdomyolysis induced by nivolumab in a patient with melanoma

Jpn J Clin Oncol. 2016 Jan;46(1):86-8. doi: 10.1093/jjco/hyv158. Epub 2015 Oct 21.


We reported an 81-year-old woman with metastatic melanoma, in whom myasthenia gravis and rhabdomyolysis developed after nivolumab monotherapy. The first symptom of myasthenia gravis was dyspnea. Ultrasonography detected hypokinesis of the bilateral diaphragm suggesting myasthenia gravis, although there was no abnormal finding of the lungs in computed tomography images. Acetylcholine receptor binding antibodies were low-titer positive in the preserved serum before administration of nivolumab, strongly suggesting that the myasthenia gravis was a nivolumab-related immune adverse event. Despite the remarkable clinical benefits of immune checkpoint inhibitors for patients with advanced melanoma, it is important to recognize unexpected immune-related adverse events.

Keywords: PD-1; melanoma; myasthenia gravis; nivolumab; rhabdomyolysis.

Publication types

  • Case Reports

MeSH terms

  • Aged, 80 and over
  • Antibodies, Monoclonal / administration & dosage
  • Antibodies, Monoclonal / adverse effects*
  • Antineoplastic Agents / administration & dosage
  • Antineoplastic Agents / adverse effects*
  • Autoantibodies / blood*
  • Female
  • Humans
  • Melanoma / drug therapy
  • Myasthenia Gravis / chemically induced*
  • Myasthenia Gravis / immunology
  • Nivolumab
  • Receptors, Cholinergic / immunology*
  • Rhabdomyolysis / chemically induced*
  • Rhabdomyolysis / immunology
  • Skin Neoplasms / drug therapy*


  • Antibodies, Monoclonal
  • Antineoplastic Agents
  • Autoantibodies
  • Receptors, Cholinergic
  • Nivolumab