Spandidos Publications Logo
  • About
    • About Spandidos
    • Aims and Scopes
    • Abstracting and Indexing
    • Editorial Policies
    • Reprints and Permissions
    • Job Opportunities
    • Terms and Conditions
    • Contact
  • Journals
    • All Journals
    • Oncology Letters
      • Oncology Letters
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Oncology
      • International Journal of Oncology
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Molecular and Clinical Oncology
      • Molecular and Clinical Oncology
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Experimental and Therapeutic Medicine
      • Experimental and Therapeutic Medicine
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Molecular Medicine
      • International Journal of Molecular Medicine
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Biomedical Reports
      • Biomedical Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Oncology Reports
      • Oncology Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Molecular Medicine Reports
      • Molecular Medicine Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • World Academy of Sciences Journal
      • World Academy of Sciences Journal
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Functional Nutrition
      • International Journal of Functional Nutrition
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Epigenetics
      • International Journal of Epigenetics
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Medicine International
      • Medicine International
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
  • Articles
  • Information
    • Information for Authors
    • Information for Reviewers
    • Information for Librarians
    • Information for Advertisers
    • Conferences
  • Language Editing
Spandidos Publications Logo
  • About
    • About Spandidos
    • Aims and Scopes
    • Abstracting and Indexing
    • Editorial Policies
    • Reprints and Permissions
    • Job Opportunities
    • Terms and Conditions
    • Contact
  • Journals
    • All Journals
    • Biomedical Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Experimental and Therapeutic Medicine
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Epigenetics
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Functional Nutrition
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Molecular Medicine
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Oncology
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Medicine International
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Molecular and Clinical Oncology
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Molecular Medicine Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Oncology Letters
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Oncology Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • World Academy of Sciences Journal
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
  • Articles
  • Information
    • For Authors
    • For Reviewers
    • For Librarians
    • For Advertisers
    • Conferences
  • Language Editing
Login Register Submit
  • This site uses cookies
  • You can change your cookie settings at any time by following the instructions in our Cookie Policy. To find out more, you may read our Privacy Policy.

    I agree
Search articles by DOI, keyword, author or affiliation
Search
Advanced Search
presentation
Medicine International
Join Editorial Board Propose a Special Issue
Print ISSN: 2754-3242 Online ISSN: 2754-1304
Journal Cover
January-February 2025 Volume 5 Issue 1

Full Size Image

Sign up for eToc alerts
Recommend to Library

Journals

International Journal of Molecular Medicine

International Journal of Molecular Medicine

International Journal of Molecular Medicine is an international journal devoted to molecular mechanisms of human disease.

International Journal of Oncology

International Journal of Oncology

International Journal of Oncology is an international journal devoted to oncology research and cancer treatment.

Molecular Medicine Reports

Molecular Medicine Reports

Covers molecular medicine topics such as pharmacology, pathology, genetics, neuroscience, infectious diseases, molecular cardiology, and molecular surgery.

Oncology Reports

Oncology Reports

Oncology Reports is an international journal devoted to fundamental and applied research in Oncology.

Experimental and Therapeutic Medicine

Experimental and Therapeutic Medicine

Experimental and Therapeutic Medicine is an international journal devoted to laboratory and clinical medicine.

Oncology Letters

Oncology Letters

Oncology Letters is an international journal devoted to Experimental and Clinical Oncology.

Biomedical Reports

Biomedical Reports

Explores a wide range of biological and medical fields, including pharmacology, genetics, microbiology, neuroscience, and molecular cardiology.

Molecular and Clinical Oncology

Molecular and Clinical Oncology

International journal addressing all aspects of oncology research, from tumorigenesis and oncogenes to chemotherapy and metastasis.

World Academy of Sciences Journal

World Academy of Sciences Journal

Multidisciplinary open-access journal spanning biochemistry, genetics, neuroscience, environmental health, and synthetic biology.

International Journal of Functional Nutrition

International Journal of Functional Nutrition

Open-access journal combining biochemistry, pharmacology, immunology, and genetics to advance health through functional nutrition.

International Journal of Epigenetics

International Journal of Epigenetics

Publishes open-access research on using epigenetics to advance understanding and treatment of human disease.

Medicine International

Medicine International

An International Open Access Journal Devoted to General Medicine.

Journal Cover
January-February 2025 Volume 5 Issue 1

Full Size Image

Sign up for eToc alerts
Recommend to Library

  • Article
  • Citations
    • Cite This Article
    • Download Citation
    • Create Citation Alert
    • Remove Citation Alert
    • Cited By
  • Similar Articles
    • Related Articles (in Spandidos Publications)
    • Similar Articles (Google Scholar)
    • Similar Articles (PubMed)
  • Download PDF
  • Download XML
  • View XML
Case Report Open Access

Myositis/myasthenia gravis caused by immune checkpoint inhibition: A report of two cases and a brief review of the literature

  • Authors:
    • Zenia Elavia
    • Victoria Jimenez
    • Roxanne Lockhart
    • Allison Muha
    • Mohamed Kazamel
  • View Affiliations / Copyright

    Affiliations: Department of Neurology, University of Alabama, Birmingham, AL 35294, USA
    Copyright: © Elavia et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY 4.0].
  • Article Number: 11
    |
    Published online on: December 3, 2024
       https://doi.org/10.3892/mi.2024.210
  • Expand metrics +
Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )
Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )
Cited By (CrossRef): 0 citations Loading Articles...

This article is mentioned in:



Abstract

Immune checkpoint inhibitors (ICIs) have revolutionized cancer therapy by enhancing the ability of the immune system to combat malignancies. Nivolumab and cemiplimab, monoclonal antibodies targeting programmed cell death protein 1, have exhibited notable therapeutic efficacy; however, they are associated with immune‑related adverse events (irAEs). The present study describes the cases of 2 patients, a 71‑year‑old male with metastatic esophageal adenocarcinoma and a 66‑year‑old female with metastatic squamous cell carcinoma who developed acute/subacute onset rapidly progressive myositis/myasthenia gravis (MG) following treatment with nivolumab and cemiplimab. Both patients had negative MG antibody panels and the first had uninformative electrodiagnostic testing, rendering the diagnosis challenging. Additionally, 1 patient had myocarditis and the other had hepatitis. The mechanisms of ICI‑induced myositis/MG remain unclear. Early recognition and intervention are vital for the prevention of severe morbidity and mortality. Treatment strategies, including the termination of the offending ICI medication, steroids, intravenous immunoglobulin (IVIG) and plasma exchange, should be tailored based on individual patient responses, and physicians should not hesitate to commence IVIG or plasma exchange once the diagnosis is established.. These cases underscore the importance of vigilance for myositis/MG in patients treated with ICIs, even with uninformative serological and electrodiagnostic testing, and the need for collaboration between multiple disciplines in managing complex irAEs including the associated myocarditis and hepatitis.
View Figures

Figure 1

View References

1 

Wang DY, Salem JE, Cohen JV, Chandra S, Menzer C, Ye F, Zhao S, Das S, Beckermann KE, Ha L, et al: Fatal toxic effects associated with immune checkpoint inhibitors: A systematic review and meta-analysis. JAMA Oncol. 4:1721–1728. 2018.PubMed/NCBI View Article : Google Scholar

2 

Tahir N, Mahboob A, Piao X, Ying G, Shrestha J, Sherchan R and Zahra F: Nivolumab, a Double-Edged Sword: A case report of nivolumab-induced myasthenia gravis. J Med Cases. 12:424–428. 2021.PubMed/NCBI View Article : Google Scholar

3 

Wilgenhof S and Neyns B: Anti-CTLA-4 antibody-induced Guillain-Barre syndrome in a melanoma patient. Ann Oncol. 22:991–993. 2011.PubMed/NCBI View Article : Google Scholar

4 

Kao JC, Liao B, Markovic SN, Klein CJ, Naddaf E, Staff NP, Liewluck T, Hammack JE, Sandroni P, Finnes H and Mauermann ML: Neurological complications associated with anti-programmed death 1 (PD-1) antibodies. JAMA Neurol. 74:1216–1222. 2017.PubMed/NCBI View Article : Google Scholar

5 

Hottinger AF: Neurologic complications of immune checkpoint inhibitors. Curr Opin Neurol. 29:806–812. 2016.PubMed/NCBI View Article : Google Scholar

6 

Haugh AM, Probasco JC and Johnson DB: Neurologic complications of immune checkpoint inhibitors. Expert Opin Drug Saf. 19:479–488. 2020.PubMed/NCBI View Article : Google Scholar

7 

Safa H, Johnson DH, Trinh VA, Rodgers TE, Lin H, Suarez-Almazor ME, Fa'ak F, Saberian C, Yee C, Davies MA, et al: Immune checkpoint inhibitor related myasthenia gravis: Single center experience and systematic review of the literature. J Immunother Cancer. 7(319)2019.PubMed/NCBI View Article : Google Scholar

8 

Weaver JM, Dodd K, Knight T, Chaudhri M, Khera R, Lilleker JB, Roberts M, Lorigan P and Cooksley T: Improved outcomes with early immunosuppression in patients with immune-checkpoint inhibitor induced myasthenia gravis, myocarditis and myositis: A case series. Support Care Cancer. 31(518)2023.PubMed/NCBI View Article : Google Scholar

9 

Grob D, Brunner N, Namba T and Pagala M: Lifetime course of myasthenia gravis. Muscle Nerve. 37:141–149. 2008.PubMed/NCBI View Article : Google Scholar

10 

Gummi RR, Kukulka NA, Deroche CB and Govindarajan R: Factors associated with acute exacerbations of myasthenia gravis. Muscle Nerve. 60:693–699. 2019.PubMed/NCBI View Article : Google Scholar

11 

Suzuki S, Utsugisawa K, Yoshikawa H, Motomura M, Matsubara S, Yokoyama K, Nagane Y, Maruta T, Satoh T, Sato H, et al: Autoimmune targets of heart and skeletal muscles in myasthenia gravis. Arch Neurol. 66:1334–1338. 2009.PubMed/NCBI View Article : Google Scholar

12 

Kang KH, Grubb W, Sawlani K, Gibson MK, Hoimes CJ, Rogers LR, Lavertu P and Yao M: Immune checkpoint-mediated myositis and myasthenia gravis: A case report and review of evaluation and management. Am J Otolaryngol. 39:642–645. 2018.PubMed/NCBI View Article : Google Scholar

13 

Kao JC, Brickshawana A and Liewluck T: Neuromuscular complications of programmed cell death-1 (PD-1) Inhibitors. Curr Neurol Neurosci Rep. 18(63)2018.PubMed/NCBI View Article : Google Scholar

14 

Kimura T, Fukushima S, Miyashita A, Aoi J, Jinnin M, Kosaka T, Ando Y, Matsukawa M, Inoue H, Kiyotani K, et al: Myasthenic crisis and polymyositis induced by one dose of nivolumab. Cancer Sci. 107:1055–1058. 2016.PubMed/NCBI View Article : Google Scholar

15 

Chen YH, Liu FC, Hsu CH and Chian CF: Nivolumab-induced myasthenia gravis in a patient with squamous cell lung carcinoma: Case report. Medicine (Baltimore). 96(e7350)2017.PubMed/NCBI View Article : Google Scholar

16 

Fazel M and Jedlowski PM: Severe myositis, myocarditis, and myasthenia gravis with elevated anti-striated muscle antibody following single dose of ipilimumab-nivolumab therapy in a patient with metastatic melanoma. Case Reports Immunol. 2019(2539493)2019.PubMed/NCBI View Article : Google Scholar

17 

Liao B, Shroff S, Kamiya-Matsuoka C and Tummala S: Atypical neurological complications of ipilimumab therapy in patients with metastatic melanoma. Neuro Oncol. 16:589–593. 2014.PubMed/NCBI View Article : Google Scholar

18 

Johnson DB, Saranga-Perry V, Lavin PJ, Burnette WB, Clark SW, Uskavitch DR, Wallace DE, Dickson MA, Kudchadkar RR and Sosman JA: Myasthenia gravis induced by ipilimumab in patients with metastatic melanoma. J Clin Oncol. 33:e122–e124. 2015.PubMed/NCBI View Article : Google Scholar

19 

Loochtan AI, Nickolich MS and Hobson-Webb LD: Myasthenia gravis associated with ipilimumab and nivolumab in the treatment of small cell lung cancer. Muscle Nerve. 52:307–308. 2015.PubMed/NCBI View Article : Google Scholar

20 

Maeda O, Yokota K, Atsuta N, Katsuno M, Akiyama M and Ando Y: Nivolumab for the treatment of malignant melanoma in a patient with pre-existing myasthenia gravis. Nagoya J Med Sci. 78:119–122. 2016.PubMed/NCBI

21 

Sciacca G, Nicoletti A, Rampello L, Noto L, Parra HJ and Zappia M: Benign form of myasthenia gravis after nivolumab treatment. Muscle Nerve. 54:507–509. 2016.PubMed/NCBI View Article : Google Scholar

22 

Shirai T, Sano T, Kamijo F, Saito N, Miyake T, Kodaira M, Katoh N, Nishie K, Okuyama R and Uhara H: Acetylcholine receptor binding antibody-associated myasthenia gravis and rhabdomyolysis induced by nivolumab in a patient with melanoma. Jpn J Clin Oncol. 46:86–88. 2016.PubMed/NCBI View Article : Google Scholar

23 

Polat P and Donofrio PD: Myasthenia gravis induced by nivolumab therapy in a patient with non-small-cell lung cancer. Muscle Nerve. 54(507)2016.PubMed/NCBI View Article : Google Scholar

24 

Chang E, Sabichi AL and Sada YH: Myasthenia gravis after nivolumab therapy for squamous cell carcinoma of the bladder. J Immunother. 40:114–116. 2017.PubMed/NCBI View Article : Google Scholar

25 

Chen JH, Lee KY, Hu CJ and Chung CC: Coexisting myasthenia gravis, myositis, and polyneuropathy induced by ipilimumab and nivolumab in a patient with non-small-cell lung cancer: A case report and literature review. Medicine (Baltimore). 96(e9262)2017.PubMed/NCBI View Article : Google Scholar

26 

Veccia A, Kinspergher S, Grego E, Peterlana D, Berti A, Tranquillini E and Caffo O: Myositis and myasthenia during nivolumab administration for advanced lung cancer: A case report and review of the literature. Anticancer Drugs. 31:540–544. 2020.PubMed/NCBI View Article : Google Scholar

27 

Jeyakumar N, Etchegaray M, Henry J, Lelenwa L, Zhao B, Segura A and Buja LM: The terrible triad of checkpoint inhibition: A case report of myasthenia gravis, myocarditis, and myositis induced by cemiplimab in a patient with metastatic cutaneous squamous cell carcinoma. Case Reports Immunol. 2020(5126717)2020.PubMed/NCBI View Article : Google Scholar

28 

Canino F, Pugliese G, Baldessari C, Greco S, Depenni R and Dominici M: Cemiplimab- and nivolumab-induced myasthenia gravis: Two clinical cases. Tumori. 107:NP123–NP126. 2021.PubMed/NCBI View Article : Google Scholar

29 

Bawek SJ, Ton R, McGovern-Poore M, Khoncarly B and Narvel R: Nivolumab-Induced myasthenia gravis concomitant with myocarditis, myositis, and hepatitis. Cureus. 13(e18040)2021.PubMed/NCBI View Article : Google Scholar

Related Articles

  • Abstract
  • View
  • Download
Copy and paste a formatted citation
Spandidos Publications style
Elavia Z, Jimenez V, Lockhart R, Muha A and Kazamel M: Myositis/myasthenia gravis caused by immune checkpoint inhibition: A report of two cases and a brief review of the literature. Med Int 5: 11, 2025.
APA
Elavia, Z., Jimenez, V., Lockhart, R., Muha, A., & Kazamel, M. (2025). Myositis/myasthenia gravis caused by immune checkpoint inhibition: A report of two cases and a brief review of the literature. Medicine International, 5, 11. https://doi.org/10.3892/mi.2024.210
MLA
Elavia, Z., Jimenez, V., Lockhart, R., Muha, A., Kazamel, M."Myositis/myasthenia gravis caused by immune checkpoint inhibition: A report of two cases and a brief review of the literature". Medicine International 5.1 (2025): 11.
Chicago
Elavia, Z., Jimenez, V., Lockhart, R., Muha, A., Kazamel, M."Myositis/myasthenia gravis caused by immune checkpoint inhibition: A report of two cases and a brief review of the literature". Medicine International 5, no. 1 (2025): 11. https://doi.org/10.3892/mi.2024.210
Copy and paste a formatted citation
x
Spandidos Publications style
Elavia Z, Jimenez V, Lockhart R, Muha A and Kazamel M: Myositis/myasthenia gravis caused by immune checkpoint inhibition: A report of two cases and a brief review of the literature. Med Int 5: 11, 2025.
APA
Elavia, Z., Jimenez, V., Lockhart, R., Muha, A., & Kazamel, M. (2025). Myositis/myasthenia gravis caused by immune checkpoint inhibition: A report of two cases and a brief review of the literature. Medicine International, 5, 11. https://doi.org/10.3892/mi.2024.210
MLA
Elavia, Z., Jimenez, V., Lockhart, R., Muha, A., Kazamel, M."Myositis/myasthenia gravis caused by immune checkpoint inhibition: A report of two cases and a brief review of the literature". Medicine International 5.1 (2025): 11.
Chicago
Elavia, Z., Jimenez, V., Lockhart, R., Muha, A., Kazamel, M."Myositis/myasthenia gravis caused by immune checkpoint inhibition: A report of two cases and a brief review of the literature". Medicine International 5, no. 1 (2025): 11. https://doi.org/10.3892/mi.2024.210
Follow us
  • Twitter
  • LinkedIn
  • Facebook
About
  • Spandidos Publications
  • Careers
  • Cookie Policy
  • Privacy Policy
How can we help?
  • Help
  • Live Chat
  • Contact
  • Email to our Support Team