Nivolumab-Induced Myocarditis Concomitant with Myasthenia Gravis

We report a 69-year-old female patient with advanced lung cancer who developed myocarditis concomitant with myasthenia gravis (MG), also known as “Herzmyasthenie,” after 3 cycles of nivolumab administration. Her initial symptoms were general malaise and double vision. However, her myocarditis deteri...

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Bibliographic Details
Published in:Case reports in oncology 2017-09, Vol.10 (3), p.809-812
Main Authors: Fukasawa, Yoko, Sasaki, Kazuya, Natsume, Maika, Nakashima, Makoto, Ota, Shuji, Watanabe, Kiyotaka, Takahashi, Yoshihisa, Kondo, Fukuo, Kozuma, Ken, Seki, Nobuhiko
Format: Article
Language:English
Subjects:
Adenocarcinoma
Angina pectoris
Anti-programmed cell death-1 monoclonal antibodies
Antigens
Apoptosis
Case Report
Case reports
Cell death
Edema
Gangrene
Heart
Herzmyasthenie
Hospitals
Immunoglobulins
Immunotherapy
Lung cancer
Lymphocytes
Monoclonal antibodies
Myasthenia gravis
Myocarditis
Nivolumab
Pathology
Patients
Targeted cancer therapy
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Summary:We report a 69-year-old female patient with advanced lung cancer who developed myocarditis concomitant with myasthenia gravis (MG), also known as “Herzmyasthenie,” after 3 cycles of nivolumab administration. Her initial symptoms were general malaise and double vision. However, her myocarditis deteriorated rapidly the following day, necessitating a temporary pacemaker and noninvasive positive pressure ventilation in the intensive care unit. Immunohistochemical examination of a myocardial biopsy suggested an immune response on the basis of HLA associations. The patient also developed impaired adduction of her left eye and elevated serum levels of acetylcholine receptor antibody, suggesting the onset of MG. Her condition gradually improved after immediate methylprednisolone pulse therapy. This case of nivolumab-induced “Herzmyasthenie” highlights the need to be aware that fulminant myocarditis might occur at the same time as MG during treatment with anti-programmed cell death-1 monoclonal antibodies.
ISSN:1662-6575
1662-6575
DOI:10.1159/000479958