Nivolumab-associated myositis myocarditis and myasthenia and anti-striated muscle antibodies

Marium Fazal; David A Prentice; Lay K Kho; Edward Fysh

doi:10.1111/imj.14946

Nivolumab-associated myositis myocarditis and myasthenia and anti-striated muscle antibodies

Intern Med J. 2020 Aug;50(8):1003-1006. doi: 10.1111/imj.14946.

Authors

Marium Fazal¹, David A Prentice¹, Lay K Kho², Edward Fysh³

Affiliations

¹ General Medicine Department, St John of God Midland Public Hospital, Perth, Western Australia, Australia.
² Neurology Department, St John of God Midland Public Hospital, Perth, Western Australia, Australia.
³ Respiratory Department, St John of God Midland Public Hospital, Perth, Western Australia, Australia.

PMID: 33306231
DOI: 10.1111/imj.14946

Abstract

An 82-year-old man was treated with neo-adjuvant nivolumab (programmed cell death protein 1 or PD-1 inhibitor) for local recurrence of melanoma developed myositis, myocarditis and a myasthenic-like syndrome with a fatal outcome. The occurrence of these three conditions may constitute a new immune checkpoint-induced syndrome. The relevance of the clinical features and the immunology is discussed. This case highlights the special role of anti-striated muscle antibodies as a predictor of mortality.

Keywords: diaphragm; immune checkpoint inhibitor; myasthenia; myocarditis; paraspinal myositis; programmed cell death protein 1, PD‐1 inhibitor.

Publication types

Case Reports

MeSH terms

Aged, 80 and over
Antineoplastic Agents, Immunological / adverse effects
Antineoplastic Agents, Immunological / therapeutic use*
Humans
Male
Melanoma / drug therapy*
Muscle, Striated / drug effects*
Myasthenia Gravis / chemically induced*
Myocarditis / chemically induced*
Myocarditis / diagnosis
Myositis / chemically induced*
Myositis / diagnosis
Neoadjuvant Therapy
Neoplasm Recurrence, Local
Nivolumab / adverse effects*
Nivolumab / therapeutic use

Substances

Antineoplastic Agents, Immunological
Nivolumab