肌炎
重症肌无力
封锁
心肌炎
医学
免疫学
补语(音乐)
免疫检查点
免疫系统
免疫疗法
内科学
生物
受体
生物化学
互补
基因
表型
作者
Christopher Nelke,Marc Pawlitzki,Ruth Kerkhoff,Christina B. Schroeter,Orhan Aktaş,Eva Neuen-Jacob,Amin Polzin,Sven G. Meuth,Tobias Ruck
标识
DOI:10.1212/nxi.0000000000200177
摘要
ObjectiveImmune checkpoint inhibitors (ICIs) have revolutionized cancer therapy but come with immune-related adverse events (irAEs) that provide a novel challenge for treating physicians. Neuromuscular irAEs, including myositis, myasthenia gravis (MG), and demyelinating polyradiculoneuropathy, lead to significant morbidity and mortality.MethodsWe present a case of severe myasthenia-myositis-myocarditis overlap in a patient receiving ICIs for breast cancer. Clinical findings were recorded.ResultsA 47-year-old woman developed tetraparesis, dysphagia, and muscle pain during ICI treatment. MG with a thymoma had been diagnosed earlier. Neuromuscular overlap irAEs with cardiac affection was confirmed, and ICI treatment was discontinued. Given a lack of clinical response to standard therapies, a muscle biopsy was performed demonstrating complement deposition. Eculizumab treatment led to rapid improvement in muscle strength and cardiac function.DiscussionNeuromuscular irAEs are associated with a high in-hospital mortality, and specific treatment strategies remain an unmet need. Here, early muscle biopsy enabled targeted therapy after standard approaches failed, thereby highlighting the value of identifying a specific treatment target. To improve therapeutic outcomes, the development of patient-tailored strategies for neuromuscular irAEs requires further studies.
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