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• Vol.59 No.8
• CLINICA NEUROL, 59: 502−508, 2019
• Vol.59 No.8 contents

Case Report

A case of myasthenia gravis and myositis induced by pembrolizumab

Tomoko Noda, M.D., Ph.D.¹⁾, Haruka Kageyama, Ph.D.¹⁾, Miki Miura, Ph.D.¹⁾, Takuya Tamura, M.D., Ph.D.¹⁾ and Hiroki Ito, M.D., Ph.D.¹⁾

¹⁾Department of Neurology, Ichinomiya Municipal Hospital

A 77-year-old woman with lung adenocarcinoma noticed bilateral ptosis 7 weeks after a first pembrolizumab infusion. Her symptoms rapidly progressed to generalized manifestations including limb and neck weakness, dyspnea, and dysphasia within the following two weeks. We diagnosed him with pembrolizumab-related myasthenia gravis and myositis based on clinical symptoms, elevation of muscle enzymes and anti-acetylcholine receptor antibodies, repetitive nerve stimulation and muscle biopsy. We commenced combination immunotherapy, including intravenous and oral steroid therapy, immune absorption therapy and plasma exchange therapy with noninvasive positive-pressure ventilation and tracheotomy positive pressure ventilation. She had gradual symptoms improvement and discharged after 209 days in a hospital. In this case, anti-titin antibodies, one of anti-striational antibodies, was positive and correlated with severity of myasthenia gravis. With the development of immune checkpoint inhibitors for various malignancies, clinicians should closely monitor patients for important immune-related adverse events and coordinate on early treatment.
Full Text of this Article in Japanese PDF (864K)

(CLINICA NEUROL, 59: 502−508, 2019)
key words: pembrolizumab, immune checkpoint inhibitor, myasthenia gravis, myositis, anti-titin antibody

(Received: 18-Nov-18)