Myasthenic crisis and polymyositis induced by one dose of nivolumab

• DOI: 10.1111/cas.12961
• Publication Date: 2016-07-15T16:44:19Z
• Authors: Toshihiro Kimura; Satoshi Fukushima; Azusa Miyashita; Jun Aoi; Masatoshi Jinnin; Takayuki Kosaka; Yukio Ando; Masakazu Matsukawa; Hiroyuki Inoue; Kazuma Kiyotani; Jae‐Hyun Park; Yusuke Nakamura; Hironobu Ihn
• Keywords: Subclinical infection

An 80‐year‐old man, who developed multiple lymph node and skin metastasis of malignant melanoma, received nivolumab monotherapy. Two weeks after the first dose, he experienced anorexia fatigue, suffered from progressive, severe dyspnea muscle weakness. We diagnosed him with myocarditis, myositis, myasthenic crisis induced by nivolumab. commenced steroid therapy, immune absorption plasma exchange i.v. immunoglobulin succeeded in saving his life. Because serum level anti‐acetylcholine receptor antibodies a sample collected before treatment were positive elevated significantly nivolumab, we suspected that triggered autoimmune response, which progressed subclinical myasthenia gravis to crisis. carried out T cell repertoire analysis using next‐generation sequencing technologies identified infiltration clonally expanded populations skeletal treatment, implying very strong response against muscular cells. To avoid immune‐related adverse events, exclusion patients disease is important for checkpoint inhibitors.