Case Report: The Neuromusclar Triad of Immune Checkpoint Inhibitors: A Case Report of Myositis, Myocarditis, and Myasthenia Gravis Overlap Following Toripalimab Treatment

被引:16
作者
Luo, Yue-Bei [1 ]
Tang, Weiting [1 ]
Zeng, Qiuming [1 ]
Duan, Weiwei [1 ]
Li, Shuyu [1 ]
Yang, Xiaosu [1 ]
Bi, Fangfang [1 ]
机构
[1] Cent South Univ, Xiangya Hosp, Dept Neurol, Changsha, Peoples R China
基金
中国国家自然科学基金;
关键词
myositis; myasthenia gravis; myocarditis; PD-1; toripalimab; IMMUNOTHERAPY; ANTIBODIES; RECEPTOR; THYMOMA; MUSCLE;
D O I
10.3389/fcvm.2021.714460
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
The neuromuscular adverse events of immune checkpoint inhibitor (ICI) treatment include myositis, polymyalgia rheumatica, myocarditis, and myasthenia syndrome. We report a 47-year old female presenting with external ophthalmoplegia, generalized muscle weakness, and third-degree atrioventricular block 4 weeks after toripalimab treatment for metastatic thymoma. Creatine kinase was elevated to 25,200 U/l and cardiac troponin I to 2.796 ng/ml. Autoantibody profiling shows positive anti-ryanodine receptor and anti-acetylcholine receptor antibodies and negative myositis specific antibodies. Repetitive nerve stimulation did not reveal decrement of compound muscle action potentials. Pulse methylprednisolone and immunoglobulin infusion, together with temporary pacemaker insertion normalized her muscle enzyme levels and cardiac rhythm. This is the first report of overlaping neuromuscular adverse event of toripalimab.
引用
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页数:5
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