Immune checkpoint-mediated myositis and myasthenia gravis: A case report and review of evaluation and management

Kylie H. Kang, William Grubb, Komal Sawlani, Michael K. Gibson, Christopher J. Hoimes, Lisa R. Rogers, Pierre Lavertu, Min Yao

Research output: Contribution to journalArticle

14 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)642-645
Number of pages4
JournalAmerican Journal of Otolaryngology - Head and Neck Medicine and Surgery
Volume39
Issue number5
DOIs
StatePublished - Sep 1 2018
Externally publishedYes

Keywords

  • Head and neck cancer
  • Immune checkpoint inhibitor
  • Immune-related adverse event
  • Myositis
  • PD-1

ASJC Scopus subject areas

  • Otorhinolaryngology

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