Myasthenia gravis induced by avelumab

Neurological immune-related adverse events are potentially life-threatening complications of immune checkpoint inhibitors. Myasthenia gravis (MG) is a rare complication of treatment with inhibitors of programmed cell death protein 1 (PD)-1 and PD ligand 1 (PD-L1). We present a patient who developed seronegative MG resulting in respiratory failure while being treated with avelumab for metastatic, treatment-refractory ovarian cancer. Her MG went into remission following steroids and maintenance intravenous immunoglobulin treatment. We conclude that MG is a rare, but potentially life-threatening immune-related adverse event of avelumab therapy. This case provides support to the hypothesis that PD-1/PD-L1 signaling may have a protective role in MG.