A Fatal Case of Immune Checkpoint Inhibitor-Mediated Myasthenia Gravis, Myositis, and Cardiomyopathy Overlap Syndrome in Urothelial Carcinoma

Cancer Rep (Hoboken). 2024 Jul;7(7):e2140. doi: 10.1002/cnr2.2140.

Abstract

Background: Immune checkpoint inhibitors (ICIs) have led to improved outcomes for many cancer types. However, their use can also precipitate immune-related adverse events (irAEs) that can affect any organ system. While irAEs are often mild, they rarely affect multiple organ systems concurrently and can be fatal.

Case: We report a fatal case of myasthenia gravis, myositis, and cardiotoxicity overlap syndrome precipitated by the ICI pembrolizumab along with a brief review of available literature.

Conclusion: Early recognition of high grade irAEs and prompt intervention is essential. Despite the poor prognosis of these overlap syndromes, current recommendations offer little guidance for severe cases and warrant a call for increased awareness and expansion of available therapeutics.

Keywords: cardiomyopathy; immune checkpoint inhibitors; immune‐related adverse events; myasthenia gravis; myositis.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Antibodies, Monoclonal, Humanized* / adverse effects
  • Carcinoma, Transitional Cell / drug therapy
  • Carcinoma, Transitional Cell / pathology
  • Cardiomyopathies / chemically induced
  • Cardiomyopathies / diagnosis
  • Fatal Outcome
  • Humans
  • Immune Checkpoint Inhibitors* / adverse effects
  • Male
  • Myasthenia Gravis* / chemically induced
  • Myasthenia Gravis* / diagnosis
  • Myositis* / chemically induced
  • Myositis* / diagnosis
  • Myositis* / immunology
  • Myositis* / pathology
  • Urinary Bladder Neoplasms / drug therapy
  • Urinary Bladder Neoplasms / pathology

Substances

  • Immune Checkpoint Inhibitors
  • pembrolizumab
  • Antibodies, Monoclonal, Humanized