Nivolumab‐associated myositis myocarditis and myasthenia and anti‐striated muscle antibodies

An 82‐year‐old man was treated with neo‐adjuvant nivolumab (programmed cell death protein 1 or PD‐1 inhibitor) for local recurrence of melanoma developed myositis, myocarditis and a myasthenic‐like syndrome with a fatal outcome. The occurrence of these three conditions may constitute a new immune ch...

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Bibliographic Details
Published in:	Internal medicine journal Vol. 50; no. 8; pp. 1003 - 1006
Main Authors:	Fazal, Marium, Prentice, David A., Kho, Lay K., Fysh, Edward
Format:	Journal Article
Language:	English
Published:	Melbourne John Wiley & Sons Australia, Ltd 01-08-2020 Wiley Subscription Services, Inc
Subjects:	Aged, 80 and over Antibodies Antineoplastic Agents, Immunological - adverse effects Antineoplastic Agents, Immunological - therapeutic use Apoptosis Cell death diaphragm Heart diseases Humans Immune checkpoint immune checkpoint inhibitor Immunotherapy Male Melanoma Melanoma - drug therapy Monoclonal antibodies Muscle, Striated - drug effects Myasthenia Myasthenia Gravis - chemically induced Myocarditis Myocarditis - chemically induced Myocarditis - diagnosis Myositis Myositis - chemically induced Myositis - diagnosis Neoadjuvant Therapy Neoplasm Recurrence, Local Neuromuscular junctions Nivolumab - adverse effects Nivolumab - therapeutic use paraspinal myositis programmed cell death protein 1, PD‐1 inhibitor Skeletal muscle diaphragm immune checkpoint inhibitor paraspinal myositis programmed cell death protein 1, PD‐1 inhibitor myasthenia myocarditis
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Summary:	An 82‐year‐old man was treated with neo‐adjuvant nivolumab (programmed cell death protein 1 or PD‐1 inhibitor) for local recurrence of melanoma developed myositis, myocarditis and a myasthenic‐like syndrome with a fatal outcome. The occurrence of these three conditions may constitute a new immune checkpoint‐induced syndrome. The relevance of the clinical features and the immunology is discussed. This case highlights the special role of anti‐striated muscle antibodies as a predictor of mortality.
ISSN:	1444-0903 1445-5994
DOI:	10.1111/imj.14946