TY - JOUR
T1 - Immune checkpoint-mediated myositis and myasthenia gravis
T2 - A case report and review of evaluation and management
AU - Kang, Kylie H.
AU - Grubb, William
AU - Sawlani, Komal
AU - Gibson, Michael K.
AU - Hoimes, Christopher J.
AU - Rogers, Lisa R.
AU - Lavertu, Pierre
AU - Yao, Min
N1 - Funding Information:
Authors MKG and CJH have the following relevant disclosures: MKG has a consulting and advisory board role with Merck and BMS; CJH has received research funding from Merck (NCT02365766), has a consulting and advisory role for Merck, BMS, and Seattle Genetics, and has received honoraria from Genentech/Roche and BMS. All other authors do not have any financial or personal relationship with other people or organizations that could inappropriately influence or bias the content of the paper.
Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2018/9/1
Y1 - 2018/9/1
N2 - Background: We present a case of myositis and possible overlapping neuromuscular junction disorder following treatment with nivolumab for recurrent/metastatic head and neck squamous cell carcinoma (HNSCC). Methods: We report a 75-year-old man with recurrent stage IVA, T1N2cM0 oral cavity HNSCC treated with weight-dosed nivolumab who presented three weeks later with severe fatigue, generalized weakness, and bilateral ptosis. Evaluation demonstrated elevated creatine kinase and myopathic motor units on electromyography, supporting a diagnosis of an underlying muscle disease. Elevated serum acetylcholine receptor binding antibodies raised the possibility of concurrent myasthenia gravis. Results: He received corticosteroids and plasmapheresis without improvement in muscle weakness. His course was complicated by bacteremia, cardiac arrest, and concerns for recurrent malignancy. Following a two-month hospital stay, he was made comfort care and died. Conclusions: With increasing usage of checkpoint inhibitors in HNSCC, clinicians must be aware of and vigilant for associated rare but serious adverse events.
AB - Background: We present a case of myositis and possible overlapping neuromuscular junction disorder following treatment with nivolumab for recurrent/metastatic head and neck squamous cell carcinoma (HNSCC). Methods: We report a 75-year-old man with recurrent stage IVA, T1N2cM0 oral cavity HNSCC treated with weight-dosed nivolumab who presented three weeks later with severe fatigue, generalized weakness, and bilateral ptosis. Evaluation demonstrated elevated creatine kinase and myopathic motor units on electromyography, supporting a diagnosis of an underlying muscle disease. Elevated serum acetylcholine receptor binding antibodies raised the possibility of concurrent myasthenia gravis. Results: He received corticosteroids and plasmapheresis without improvement in muscle weakness. His course was complicated by bacteremia, cardiac arrest, and concerns for recurrent malignancy. Following a two-month hospital stay, he was made comfort care and died. Conclusions: With increasing usage of checkpoint inhibitors in HNSCC, clinicians must be aware of and vigilant for associated rare but serious adverse events.
KW - Head and neck cancer
KW - Immune checkpoint inhibitor
KW - Immune-related adverse event
KW - Myositis
KW - PD-1
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U2 - 10.1016/j.amjoto.2018.06.003
DO - 10.1016/j.amjoto.2018.06.003
M3 - Article
C2 - 29903623
AN - SCOPUS:85048469707
SN - 0196-0709
VL - 39
SP - 642
EP - 645
JO - American Journal of Otolaryngology - Head and Neck Medicine and Surgery
JF - American Journal of Otolaryngology - Head and Neck Medicine and Surgery
IS - 5
ER -
