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- Ryoko Shibuya, Kousuke Baba, Risako Furuta, Hiroki Maesaka, Hiroaki Hirosawa, Tadashi Bando, Akira Oshima, Hiroshi Onoda, Takamasa Nukui, Nobuhiro Dougu, Shuji Joho, and Yuji Nakatsuji.
- Department of Neurology, Faculty of Medicine, University of Toyama, Japan.
- Intern. Med. 2024 Aug 1; 63 (15): 219321982193-2198.
AbstractAn 83-year-old man with hepatocellular carcinoma developed muscle weakness, ptosis, and dyspnea 3 weeks after receiving atezolizumab. Soon after, mechanical ventilation was initiated, which was followed by marked blood pressure spikes. The levels of creatine kinase and troponin-I were significantly elevated, and acetylcholine receptor antibodies were positive. The patient was diagnosed with immune checkpoint inhibitor (ICI)-induced myositis, myasthenia gravis (MG), myocarditis, and suspected autoimmune autonomic ganglionopathy (AAG). After immunotherapy, the serum markers and blood pressure normalized, and he was weaned from the ventilator after five months. To our knowledge, this is the first reported case of AAG secondary to ICI-induced myositis, MG, and myocarditis.
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