A Rare Case of Overlapping Durvalumab-induced Myositis, Takotsubo-like Morphological Changes Caused by Myocarditis, and Myasthenia Gravis

Shoichiro Saito; Shigeto Hontsu; Junya Hiraoka; Ai Yamanaka; Nobuhiro Fujioka; Daisuke Shimada; Yosuke Okuda; Kazuma Sugie; Shigeo Muro

doi:10.2169/internalmedicine.3028-23

Shoichiro Saito, Shigeto Hontsu, Junya Hiraoka, Ai Yamanaka, Nobuhiro Fujioka, Daisuke Shimada, Yosuke Okuda, Kazuma Sugie, Shigeo Muro

Author information

Shoichiro Saito
Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Japan
Shigeto Hontsu
Department of Respiratory Medicine, Nara Medical University, Japan
Junya Hiraoka
Department of Respiratory Medicine, Nara Medical University, Japan
Ai Yamanaka
Department of Neurology, Nara Medical University, Japan
Nobuhiro Fujioka
Department of Respiratory Medicine, Nara Medical University, Japan
Daisuke Shimada
Department of Neurology, Nara Medical University, Japan
Yosuke Okuda
Department of Respiratory Medicine, Nara Medical University, Japan
Kazuma Sugie
Department of Neurology, Nara Medical University, Japan
Shigeo Muro
Department of Respiratory Medicine, Nara Medical University, Japan

Keywords: immune checkpoint inhibitors, immune-related adverse events, ICI-induced myasthenia gravis, intravenous immunoglobulin, plasmapheresis, Takotsubo cardiomyopathy

JOURNAL OPEN ACCESS Advance online publication

Article ID: 3028-23

DOI https://doi.org/10.2169/internalmedicine.3028-23

Details

Abstract

Immune checkpoint inhibitors can cause a range of immune-related adverse events, including myositis, Takotsubo cardiomyopathy, and myasthenia gravis. We herein report a rare case of a 78-year-old man with concurrent durvalumab-induced myositis, Takotsubo-like morphological changes caused by myocarditis, and myasthenia gravis. The patient initially required invasive ventilation and exhibited symptoms of myasthenia gravis after treatment with high-dose steroids. However, he subsequently achieved successful recovery after the administration of intravenous immunoglobulin, plasmapheresis, and high-dose steroids. We advocate vigilant neurological monitoring of patients with immune checkpoint inhibitor-induced myositis, including the assessment of ptosis and other relevant signs, so that prompt treatment can be initiated at the time of emergence or progression of immune checkpoint inhibitor-induced myasthenia gravis.

Corresponding author

Register with J-STAGE for free!