Myasthenia triggered by immune checkpoint inhibitors: New case and literature review

B cells in the pathophysiology of myasthenia gravis

“…Collectively, with immunotherapy becoming front-line treatment for many cancer types, the number of reports describing exacerbated or emerging MG following the use of checkpointinhibitor immunotherapy continues to grow rapidly. [182][183][184] Therefore, prior to treatment, patients must be carefully scrutinized for any autoimmune diseases, family history of such, and current physical condition. Knowing a patient's likelihood of an adverse event following immunotherapy assists clinicians in maximizing the power of immunotherapy while limiting side effects.…”

Refractory myasthenia gravis exacerbation triggered By pembrolizumab

“…Thus, blockade of PD‐1 results in T‐cell dysregulation, a likely pathogenic mechanism for triggering autoimmune conditions such as MG . There are 9 previously reported cases of MG triggered by pembrolizumab, 2 of which were fatal . There are 2 other reports of fatal MG associated with other immune checkpoint inhibitors, 1 following cotreatment with nivolumab and ipilimumab and another following nivolumab, although management of myasthenic crisis was declined in this case .…”

Pembrolizumab‐induced myasthenia gravis with myositis in a patient with lung cancer

“…Of these, nine cases were new‐onset MG , and four cases were exacerbations of pre‐existing MG . Ten cases were of metastatic melanoma , and the remaining three cases were of thymic cancer , uterine carcinosarcoma , and lung squamous cell cancer (our case), respectively. Only five of these cases presented CPK elevation (reported as 10,386 IU/L, 4361 IU/L [our case], 2125 IU/L, 1200 IU/L, and “slightly elevated”).…”