Camrelizumab-Related Myocarditis and Myositis With Myasthenia Gravis: A Case Report and Literature Review

Abstract

Immune checkpoint inhibitors (ICIs) have substantially changed the treatment of a variety of malignant tumors. With the increasing of their usage, the unique immune-mediated toxicity profile of ICIs has become apparent. We report a case of esophageal squamous cell carcinoma in a patient who received anti-programmed cell death protein 1 (PD-1) (camrelizumab) therapy and the occurrence of sequential immune-related adverse events (irAEs). Although many irAEs have been reported, severe myositis caused by camrelizumab with simultaneous involvement of multiple organs, including the myocardium, respiratory muscles, and skeletal muscles, has rarely been described in literature. This 69-year-old male patient developed a grade 4 camrelizumab-induced adverse reaction according to the Common Terminology Criteria for Adverse Events (CTCAE) and was successfully treated with methylprednisolone and immunoglobulins. The early identification of irAEs, immediate discontinuation of immunotherapy, use of steroids and/or immunosuppressants, and adjuvant supportive treatment are critical to the clinical prognosis of patients. It should be aware that autoimmune complications can occur even when ICI treatment is ceased.

Acetylcholine receptor binding antibody–associated myasthenia gravis, myocarditis, and rhabdomyolysis induced by tislelizumab in a patient with colon cancer: A case report and literature review

“…Furthermore, in retrospective case-control study researchers found neuromuscular decompensation to be more pronounced in patients with anti–PD-1 treatment ( 47 ). It has been more previously reported that patients with a history of MG or positive anti-AChR antibody presented a myasthenic crisis after ICI treatment ( 48 – 51 ) compared with patients without a history of MG. For patients with a history of MG, the use of ICIs might activate the T-cell autoimmune response and may induce MG. For acetylcholine receptor antibody-positive MG patients, high doses of corticosteroids alone can exasperate the myasthenic crisis, and ASCO guideline recommend high doses of corticosteroids combined with gamma globulin or plasma replacement as first-line treatment ( 17 ).…”

Exploring the role of immune checkpoint inhibitors in the etiology of myasthenia gravis and Lambert-Eaton myasthenic syndrome: A systematic review

“…Several systematic reviews and meta-analyses investigating the role of ICIs in irAEs have been published (9,(14)(15)(16)(17)(18)(19)(20)(21). Past case reports and narrative reviews have also summarized the literature describing an association of ICIs with MG (22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41). However, to the best of our knowledge, a rigorous analysis of the relationship between ICIs and both MG and LEMS has not been undertaken.…”

Late‑onset immune checkpoint inhibitor‑related pneumonitis after cessation of sintilimab: A case report and literature review

“…Over the last decade, immune checkpoint inhibitors (ICIs) have shown considerable potential due to reports of their impressive efficacy in the field of oncotherapy (1), which has resulted in the development of radical novel strategies for treating various malignancies (2). Instead of killing tumour cells by direct exposure, ICIs function by regulating the behaviour of immune cells, such as T-cells (3).…”