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Case Report Open Access

Rhabdomyolysis in a patient with lung cancer with sintilimab‑induced overlap syndrome and hypothyroidism: A case report

  • Authors:
    • Bingyi Chen
    • Yi Liu
    • Qin Zeng
    • Shitong Yan
    • Xiujuan Liu
    • Quanlin Zhao
  • View Affiliations / Copyright

    Affiliations: The First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250014, P.R. China, Department of Cardiovascular Diseases, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250014, P.R. China, Department of Geriatrics, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250014, P.R. China
    Copyright: © Chen et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY_NC 4.0].
  • Article Number: 115
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    Published online on: February 17, 2026
       https://doi.org/10.3892/etm.2026.13110
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Abstract

The use of immune checkpoint inhibitors (ICIs) has significantly improved outcomes in advanced malignancies, although these may induce immune‑related adverse events (irAEs) involving multiple organ systems. The present case study reported on a 65‑year‑old man with squamous cell lung carcinoma who developed bilateral limb edema, profound fatigue and muscle weakness following chemotherapy, immunosuppressive therapy and iodine‑125 brachytherapy. Laboratory tests revealed markedly elevated levels of creatine kinase and other muscle enzymes, overt hypothyroidism and positive antinuclear antibodies, consistent with overlapping immune‑mediated myopathy and endocrine dysfunction. The patient was treated with diuretics, levothyroxine and tapering glucocorticoids, which led to a resolution of the symptoms, the normalization of enzyme levels and restoration of thyroid function. The excessive immune activation associated with ICI therapy, in combination with the hypometabolic state caused by hypothyroidism, may have acted as a synergistic ‘double‑hit’ to skeletal muscle, which thereby contributed to the development of rhabdomyolysis (RM). This case highlights the need for vigilant monitoring of both musculoskeletal and endocrine systems in patients on ICIs, as the early recognition of irAEs is crucial to prevent life‑threatening complications such as RM.
View Figures

Figure 1

MRI of both thighs. The arrows
indicate high signal intensity in the adductor muscle group and
hamstring muscle group. (A) Oedema is seen in the vastus lateralis,
intermedius femoris and semitendinosus muscles bilaterally. (B)
Sagittal and (C) transverse angular views are shown.

Figure 2

Dynamic changes in cardiac enzymes,
and thyroid function during hospitalization and post-discharge
review are shown. CK-MB, creatine kinase-myocardial band; eGFR,
estimated glomerular filtration rate; TSH, thyroid-stimulating
hormone.

Figure 3

Timeline of disease progression and
treatment interventions. NSCLC, non-small cell lung cancer; SqCC,
squamous cell cancer; CK, creatine kinase; FT3, free
triiodothyronine; FT4, free thyroxine; TSH,
thyroid-stimulating hormone; ICI, immune checkpoint inhibitor;
L-T4, levothyroxine.
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Copy and paste a formatted citation
Spandidos Publications style
Chen B, Liu Y, Zeng Q, Yan S, Liu X and Zhao Q: Rhabdomyolysis in a patient with lung cancer with sintilimab‑induced overlap syndrome and hypothyroidism: A case report. Exp Ther Med 31: 115, 2026.
APA
Chen, B., Liu, Y., Zeng, Q., Yan, S., Liu, X., & Zhao, Q. (2026). Rhabdomyolysis in a patient with lung cancer with sintilimab‑induced overlap syndrome and hypothyroidism: A case report. Experimental and Therapeutic Medicine, 31, 115. https://doi.org/10.3892/etm.2026.13110
MLA
Chen, B., Liu, Y., Zeng, Q., Yan, S., Liu, X., Zhao, Q."Rhabdomyolysis in a patient with lung cancer with sintilimab‑induced overlap syndrome and hypothyroidism: A case report". Experimental and Therapeutic Medicine 31.4 (2026): 115.
Chicago
Chen, B., Liu, Y., Zeng, Q., Yan, S., Liu, X., Zhao, Q."Rhabdomyolysis in a patient with lung cancer with sintilimab‑induced overlap syndrome and hypothyroidism: A case report". Experimental and Therapeutic Medicine 31, no. 4 (2026): 115. https://doi.org/10.3892/etm.2026.13110
Copy and paste a formatted citation
x
Spandidos Publications style
Chen B, Liu Y, Zeng Q, Yan S, Liu X and Zhao Q: Rhabdomyolysis in a patient with lung cancer with sintilimab‑induced overlap syndrome and hypothyroidism: A case report. Exp Ther Med 31: 115, 2026.
APA
Chen, B., Liu, Y., Zeng, Q., Yan, S., Liu, X., & Zhao, Q. (2026). Rhabdomyolysis in a patient with lung cancer with sintilimab‑induced overlap syndrome and hypothyroidism: A case report. Experimental and Therapeutic Medicine, 31, 115. https://doi.org/10.3892/etm.2026.13110
MLA
Chen, B., Liu, Y., Zeng, Q., Yan, S., Liu, X., Zhao, Q."Rhabdomyolysis in a patient with lung cancer with sintilimab‑induced overlap syndrome and hypothyroidism: A case report". Experimental and Therapeutic Medicine 31.4 (2026): 115.
Chicago
Chen, B., Liu, Y., Zeng, Q., Yan, S., Liu, X., Zhao, Q."Rhabdomyolysis in a patient with lung cancer with sintilimab‑induced overlap syndrome and hypothyroidism: A case report". Experimental and Therapeutic Medicine 31, no. 4 (2026): 115. https://doi.org/10.3892/etm.2026.13110
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