Anti-Kv1.4 Antibody-positive Nivolumab-induced Myasthenia Gravis and Myositis Presenting with Bilateral Ptosis and Demonstrating Different Pathophysiologies

Yuki Kitazaki; Osamu Yamamura; Kojiro Usui; Asako Ueno; Sayaka Sanada; Hirohito Sasaki; Yoshinori Endo; Soichi Enomoto; Masamichi Ikawa; Yasunari Nakamoto; Tadanori Hamano

doi:10.2169/internalmedicine.0739-22

CASE REPORTS

Anti-Kv1.4 Antibody-positive Nivolumab-induced Myasthenia Gravis and Myositis Presenting with Bilateral Ptosis and Demonstrating Different Pathophysiologies

Yuki Kitazaki, Osamu Yamamura, Kojiro Usui, Asako Ueno, Sayaka Sanada, Hirohito Sasaki, Yoshinori Endo, Soichi Enomoto, Masamichi Ikawa, Yasunari Nakamoto, Tadanori Hamano

Author information

Yuki Kitazaki
Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Japan
Osamu Yamamura
Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Japan
Department of Community Medicine, Faculty of Medical Science, University of Fukui, Japan
Kojiro Usui
Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Japan
Asako Ueno
Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Japan
Department of Neurology, Fukui-ken Saiseikai Hospital, Japan
Sayaka Sanada
Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Japan
Hirohito Sasaki
Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Japan
Yoshinori Endo
Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Japan
Soichi Enomoto
Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Japan
Masamichi Ikawa
Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Japan
Department of Advanced Medicine for Community Healthcare, Faculty of Medical Sciences, University of Fukui, Japan
Yasunari Nakamoto
Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Japan
Tadanori Hamano
Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Japan
Department of Aging and Dementia, Faculty of Medical Sciences, University of Fukui, Japan

Keywords: immune-related adverse event, myasthenia gravis, nivolumab, anti-muscular voltage-gated potassium channel antibodies, facial paralysis

JOURNAL OPEN ACCESS

2023 Volume 62 Issue 20 Pages 3013-3020

DOI https://doi.org/10.2169/internalmedicine.0739-22

Details

Abstract

Nivolumab blocks inhibitors of T-cell activation and restores antitumor immunity but promotes T-cell activity in host tissues by blocking inhibition of the T-cell function, resulting in immune-related adverse effects. We herein report an 80-year-old man presenting with nivolumab-related myasthenia gravis with anti-muscular voltage-gated potassium channel-complex (Kv1.4) antibodies. On day 29 after nivolumab administration, he simultaneously developed rapidly progressing right ptosis and left facial paralysis. Nivolumab administration was discontinued. He subsequently presented with bulbar paralysis, dyspnea, and muscle weakness and received intravenous immunoglobulin, methylprednisolone, and plasma exchange. The severity of nivolumab-related myasthenia gravis with anti-Kv1.4 antibodies presented with diverse clinical findings.

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