Immune checkpoint inhibitor-mediated myasthenia gravis with focal subclinical myocarditis progressing to symptomatic cardiac disease
The advent of immune checkpoint inhibitors (ICIs) for cancer therapy has heralded increasing frequency of immune-related adverse events including endocrinopathies, hepatitis, colitis and rarely myocarditis and myasthenia gravis (MG). The heterogeneity in clinical presentations regardless of organ-sp...
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| Veröffentlicht in: | BMJ case reports 2020-05, Vol.13 (5), p.e232920 |
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| creator | Leaver, Phillip John Jang, Helena Sung-In Vernon, Stephen Thomas Fernando, Suran Loshana |
| description | The advent of immune checkpoint inhibitors (ICIs) for cancer therapy has heralded increasing frequency of immune-related adverse events including endocrinopathies, hepatitis, colitis and rarely myocarditis and myasthenia gravis (MG). The heterogeneity in clinical presentations regardless of organ-specific involvement can lead to delayed recognition and management of these events and adverse health outcomes. We describe a case of ICI-induced subclinical focal myocarditis that was recognised and treated in the broader context of MG. It is essential that patients with ICI-induced MG should be screened and monitored for myocarditis, a potentially fatal complication. |
| doi_str_mv | 10.1136/bcr-2019-232920 |
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The heterogeneity in clinical presentations regardless of organ-specific involvement can lead to delayed recognition and management of these events and adverse health outcomes. We describe a case of ICI-induced subclinical focal myocarditis that was recognised and treated in the broader context of MG. It is essential that patients with ICI-induced MG should be screened and monitored for myocarditis, a potentially fatal complication.</description><identifier>ISSN: 1757-790X</identifier><identifier>EISSN: 1757-790X</identifier><identifier>DOI: 10.1136/bcr-2019-232920</identifier><identifier>PMID: 32404371</identifier><language>eng</language><publisher>England: BMJ Publishing Group Ltd</publisher><subject>Antigens ; Autoimmune diseases ; Brain Neoplasms - drug therapy ; Brain Neoplasms - secondary ; Cardiovascular disease ; Case reports ; Coronary vessels ; Diagnosis, Differential ; Diplopia ; Ejection fraction ; Family medical history ; Heart attacks ; Heart failure ; Heart Failure - chemically induced ; Heart Failure - diagnostic imaging ; Heart Failure - drug therapy ; Hepatitis ; Humans ; Immune Checkpoint Inhibitors - administration & dosage ; Immune Checkpoint Inhibitors - adverse effects ; Immunotherapy ; Ipilimumab - administration & dosage ; Ipilimumab - adverse effects ; Kinases ; Lung Neoplasms - drug therapy ; Lung Neoplasms - secondary ; Lymphocytes ; Male ; malignant disease and immunosuppression ; Medical diagnosis ; Melanoma ; Melanoma - drug therapy ; Melanoma - pathology ; Metastasis ; Middle Aged ; Myasthenia gravis ; Myasthenia Gravis - chemically induced ; Myasthenia Gravis - diagnostic imaging ; Myasthenia Gravis - drug therapy ; Myocarditis ; Myocarditis - chemically induced ; Myocarditis - diagnostic imaging ; Myocarditis - drug therapy ; Nivolumab - administration & dosage ; Nivolumab - adverse effects ; radiology (diagnostics) ; Serology ; Skin cancer ; T cell receptors ; Unexpected Outcome (Positive or Negative) Including Adverse Drug Reactions ; unwanted effects / adverse reactions</subject><ispartof>BMJ case reports, 2020-05, Vol.13 (5), p.e232920</ispartof><rights>BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>2020 BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ. 2020</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b492t-e2f49dedad25963f612651ff8b8f9ca01563a94fed77fa0aa6814d98fee813fd3</citedby><cites>FETCH-LOGICAL-b492t-e2f49dedad25963f612651ff8b8f9ca01563a94fed77fa0aa6814d98fee813fd3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7228148/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7228148/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,27923,27924,53790,53792</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32404371$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Leaver, Phillip John</creatorcontrib><creatorcontrib>Jang, Helena Sung-In</creatorcontrib><creatorcontrib>Vernon, Stephen Thomas</creatorcontrib><creatorcontrib>Fernando, Suran Loshana</creatorcontrib><title>Immune checkpoint inhibitor-mediated myasthenia gravis with focal subclinical myocarditis progressing to symptomatic cardiac disease</title><title>BMJ case reports</title><addtitle>BMJ Case Rep</addtitle><addtitle>BMJ Case Rep</addtitle><description>The advent of immune checkpoint inhibitors (ICIs) for cancer therapy has heralded increasing frequency of immune-related adverse events including endocrinopathies, hepatitis, colitis and rarely myocarditis and myasthenia gravis (MG). The heterogeneity in clinical presentations regardless of organ-specific involvement can lead to delayed recognition and management of these events and adverse health outcomes. We describe a case of ICI-induced subclinical focal myocarditis that was recognised and treated in the broader context of MG. It is essential that patients with ICI-induced MG should be screened and monitored for myocarditis, a potentially fatal complication.</description><subject>Antigens</subject><subject>Autoimmune diseases</subject><subject>Brain Neoplasms - drug therapy</subject><subject>Brain Neoplasms - secondary</subject><subject>Cardiovascular disease</subject><subject>Case reports</subject><subject>Coronary vessels</subject><subject>Diagnosis, Differential</subject><subject>Diplopia</subject><subject>Ejection fraction</subject><subject>Family medical history</subject><subject>Heart attacks</subject><subject>Heart failure</subject><subject>Heart Failure - chemically induced</subject><subject>Heart Failure - diagnostic imaging</subject><subject>Heart Failure - drug therapy</subject><subject>Hepatitis</subject><subject>Humans</subject><subject>Immune Checkpoint Inhibitors - administration & dosage</subject><subject>Immune Checkpoint Inhibitors - adverse effects</subject><subject>Immunotherapy</subject><subject>Ipilimumab - administration & dosage</subject><subject>Ipilimumab - adverse effects</subject><subject>Kinases</subject><subject>Lung Neoplasms - drug therapy</subject><subject>Lung Neoplasms - secondary</subject><subject>Lymphocytes</subject><subject>Male</subject><subject>malignant disease and immunosuppression</subject><subject>Medical diagnosis</subject><subject>Melanoma</subject><subject>Melanoma - drug therapy</subject><subject>Melanoma - pathology</subject><subject>Metastasis</subject><subject>Middle Aged</subject><subject>Myasthenia gravis</subject><subject>Myasthenia Gravis - chemically induced</subject><subject>Myasthenia Gravis - diagnostic imaging</subject><subject>Myasthenia Gravis - drug therapy</subject><subject>Myocarditis</subject><subject>Myocarditis - chemically induced</subject><subject>Myocarditis - diagnostic imaging</subject><subject>Myocarditis - drug therapy</subject><subject>Nivolumab - administration & dosage</subject><subject>Nivolumab - adverse effects</subject><subject>radiology (diagnostics)</subject><subject>Serology</subject><subject>Skin cancer</subject><subject>T cell receptors</subject><subject>Unexpected Outcome (Positive or Negative) Including Adverse Drug Reactions</subject><subject>unwanted effects / adverse reactions</subject><issn>1757-790X</issn><issn>1757-790X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqNkc9rFDEUx4MottSevUnAmzI2v3ZmchGkaFsoeFHwFt7kx07WnWRMMpW9-4ebdetaD4K5vEfeJ9_3DV-EnlPyhlLeXgw6NYxQ2TDOJCOP0CntVl3TSfLl8YP-BJ3nvCH1cCp6wZ-iE84EEbyjp-jHzTQtwWI9Wv11jj4U7MPoB19iaiZrPBRr8LSDXEYbPOB1gjuf8XdfRuyihi3Oy6C3Pvh9P-3qVTK-VGROcZ1szj6scYk476a5xAmK1_gXAxobny1k-ww9cbDN9vy-nqHPH95_urxubj9e3Vy-u20GIVlpLHNCGmvAsJVsuWspa1fUuX7ondRA6KrlIIWzpuscEIC2p8LI3lnbU-4MP0NvD7rzMtS_aRtKgq2ak58g7VQEr_6eBD-qdbxTHWNVqq8CL-8FUvy22FzUJi4pVM-KCU5kJ2QvK3VxoHSKOSfrjhsoUfvkVE1O7ZNTh-TqixcPjR353zlV4NUBGKbNf6i9_gMfDf6L_gmukLRg</recordid><startdate>20200513</startdate><enddate>20200513</enddate><creator>Leaver, Phillip John</creator><creator>Jang, Helena Sung-In</creator><creator>Vernon, Stephen Thomas</creator><creator>Fernando, Suran Loshana</creator><general>BMJ Publishing Group Ltd</general><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>5PM</scope></search><sort><creationdate>20200513</creationdate><title>Immune checkpoint inhibitor-mediated myasthenia gravis with focal subclinical myocarditis progressing to symptomatic cardiac disease</title><author>Leaver, Phillip John ; Jang, Helena Sung-In ; Vernon, Stephen Thomas ; Fernando, Suran Loshana</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b492t-e2f49dedad25963f612651ff8b8f9ca01563a94fed77fa0aa6814d98fee813fd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Antigens</topic><topic>Autoimmune diseases</topic><topic>Brain Neoplasms - drug therapy</topic><topic>Brain Neoplasms - secondary</topic><topic>Cardiovascular disease</topic><topic>Case reports</topic><topic>Coronary vessels</topic><topic>Diagnosis, Differential</topic><topic>Diplopia</topic><topic>Ejection fraction</topic><topic>Family medical history</topic><topic>Heart attacks</topic><topic>Heart failure</topic><topic>Heart Failure - chemically induced</topic><topic>Heart Failure - diagnostic imaging</topic><topic>Heart Failure - drug therapy</topic><topic>Hepatitis</topic><topic>Humans</topic><topic>Immune Checkpoint Inhibitors - administration & dosage</topic><topic>Immune Checkpoint Inhibitors - adverse effects</topic><topic>Immunotherapy</topic><topic>Ipilimumab - administration & dosage</topic><topic>Ipilimumab - adverse effects</topic><topic>Kinases</topic><topic>Lung Neoplasms - drug therapy</topic><topic>Lung Neoplasms - secondary</topic><topic>Lymphocytes</topic><topic>Male</topic><topic>malignant disease and immunosuppression</topic><topic>Medical diagnosis</topic><topic>Melanoma</topic><topic>Melanoma - drug therapy</topic><topic>Melanoma - pathology</topic><topic>Metastasis</topic><topic>Middle Aged</topic><topic>Myasthenia gravis</topic><topic>Myasthenia Gravis - chemically induced</topic><topic>Myasthenia Gravis - diagnostic imaging</topic><topic>Myasthenia Gravis - drug therapy</topic><topic>Myocarditis</topic><topic>Myocarditis - chemically induced</topic><topic>Myocarditis - diagnostic imaging</topic><topic>Myocarditis - drug therapy</topic><topic>Nivolumab - administration & dosage</topic><topic>Nivolumab - adverse effects</topic><topic>radiology (diagnostics)</topic><topic>Serology</topic><topic>Skin cancer</topic><topic>T cell receptors</topic><topic>Unexpected Outcome (Positive or Negative) Including Adverse Drug Reactions</topic><topic>unwanted effects / adverse reactions</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Leaver, Phillip John</creatorcontrib><creatorcontrib>Jang, Helena Sung-In</creatorcontrib><creatorcontrib>Vernon, Stephen Thomas</creatorcontrib><creatorcontrib>Fernando, Suran Loshana</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMJ case reports</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Leaver, Phillip John</au><au>Jang, Helena Sung-In</au><au>Vernon, Stephen Thomas</au><au>Fernando, Suran Loshana</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Immune checkpoint inhibitor-mediated myasthenia gravis with focal subclinical myocarditis progressing to symptomatic cardiac disease</atitle><jtitle>BMJ case reports</jtitle><stitle>BMJ Case Rep</stitle><addtitle>BMJ Case Rep</addtitle><date>2020-05-13</date><risdate>2020</risdate><volume>13</volume><issue>5</issue><spage>e232920</spage><pages>e232920-</pages><issn>1757-790X</issn><eissn>1757-790X</eissn><abstract>The advent of immune checkpoint inhibitors (ICIs) for cancer therapy has heralded increasing frequency of immune-related adverse events including endocrinopathies, hepatitis, colitis and rarely myocarditis and myasthenia gravis (MG). The heterogeneity in clinical presentations regardless of organ-specific involvement can lead to delayed recognition and management of these events and adverse health outcomes. We describe a case of ICI-induced subclinical focal myocarditis that was recognised and treated in the broader context of MG. It is essential that patients with ICI-induced MG should be screened and monitored for myocarditis, a potentially fatal complication.</abstract><cop>England</cop><pub>BMJ Publishing Group Ltd</pub><pmid>32404371</pmid><doi>10.1136/bcr-2019-232920</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Antigens Autoimmune diseases Brain Neoplasms - drug therapy Brain Neoplasms - secondary Cardiovascular disease Case reports Coronary vessels Diagnosis, Differential Diplopia Ejection fraction Family medical history Heart attacks Heart failure Heart Failure - chemically induced Heart Failure - diagnostic imaging Heart Failure - drug therapy Hepatitis Humans Immune Checkpoint Inhibitors - administration & dosage Immune Checkpoint Inhibitors - adverse effects Immunotherapy Ipilimumab - administration & dosage Ipilimumab - adverse effects Kinases Lung Neoplasms - drug therapy Lung Neoplasms - secondary Lymphocytes Male malignant disease and immunosuppression Medical diagnosis Melanoma Melanoma - drug therapy Melanoma - pathology Metastasis Middle Aged Myasthenia gravis Myasthenia Gravis - chemically induced Myasthenia Gravis - diagnostic imaging Myasthenia Gravis - drug therapy Myocarditis Myocarditis - chemically induced Myocarditis - diagnostic imaging Myocarditis - drug therapy Nivolumab - administration & dosage Nivolumab - adverse effects radiology (diagnostics) Serology Skin cancer T cell receptors Unexpected Outcome (Positive or Negative) Including Adverse Drug Reactions unwanted effects / adverse reactions |
| title | Immune checkpoint inhibitor-mediated myasthenia gravis with focal subclinical myocarditis progressing to symptomatic cardiac disease |
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