Simultaneous pembrolizumab-induced myasthenia gravis and myocarditis in a patient with metastatic bladder cancer: A case report

Manabu Takai; Daiki Kato; Koji Iinuma; Yuka Muramatsu Maekawa; Keita Nakane; Tomohiro Tsuchiya; Shigeaki Yokoi; Takuya Koie

doi:10.1016/j.eucr.2020.101145

Simultaneous pembrolizumab-induced myasthenia gravis and myocarditis in a patient with metastatic bladder cancer: A case report

Urol Case Rep. 2020 Feb 26:31:101145. doi: 10.1016/j.eucr.2020.101145. eCollection 2020 Jul.

Authors

Manabu Takai¹, Daiki Kato¹, Koji Iinuma¹, Yuka Muramatsu Maekawa¹, Keita Nakane¹, Tomohiro Tsuchiya¹, Shigeaki Yokoi², Takuya Koie¹

Affiliations

¹ Department of Urology, Gifu University Graduate School of Medicine, Gifu, 501-1194, Japan.
² Department of Urology, Kizawa Memorial Hospital, Minokamo, 505-8503, Japan.

Abstract

We report a fatal case of pembrolizumab-induced myasthenia gravis and myocarditis in a patient with metastatic bladder cancer. A 77-year-old man was aware of eye ptosis and diplopia after three weeks from first infusion of pembrolizumab, an anti-programmed cell death protein 1 monoclonal antibodies. He was diagnosed with myasthenia gravis, because he was positive on the edrophonium test and acetylcholine receptor antibody. As his echocardiography also revealed diffuse loss in wall motion with ejection fraction 29%, he was strongly suspected myocarditis. Although he was treated with prednisone and intravenous immunoglobulin, he was suddenly in cardiac arrest and passed away.

Keywords: AEs, adverse events; AchR, acetylcholine receptor; CT, computed tomography; IVIG, intravenous immunoglobulin; MG, myasthenia gravis; MuSK, anti-muscle-specific kinase; irAEs, immune-related AEs.

Publication types

Case Reports