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Immune checkpoint-mediated myositis and myasthenia gravis: A case report and review of evaluation and management.

Publication ,  Journal Article
Kang, KH; Grubb, W; Sawlani, K; Gibson, MK; Hoimes, CJ; Rogers, LR; Lavertu, P; Yao, M
Published in: Am J Otolaryngol
2018

BACKGROUND: We present a case of myositis and possible overlapping neuromuscular junction disorder following treatment with nivolumab for recurrent/metastatic head and neck squamous cell carcinoma (HNSCC). METHODS: We report a 75-year-old man with recurrent stage IVA, T1N2cM0 oral cavity HNSCC treated with weight-dosed nivolumab who presented three weeks later with severe fatigue, generalized weakness, and bilateral ptosis. Evaluation demonstrated elevated creatine kinase and myopathic motor units on electromyography, supporting a diagnosis of an underlying muscle disease. Elevated serum acetylcholine receptor binding antibodies raised the possibility of concurrent myasthenia gravis. RESULTS: He received corticosteroids and plasmapheresis without improvement in muscle weakness. His course was complicated by bacteremia, cardiac arrest, and concerns for recurrent malignancy. Following a two-month hospital stay, he was made comfort care and died. CONCLUSIONS: With increasing usage of checkpoint inhibitors in HNSCC, clinicians must be aware of and vigilant for associated rare but serious adverse events.

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Published In

Am J Otolaryngol

DOI

EISSN

1532-818X

Publication Date

2018

Volume

39

Issue

5

Start / End Page

642 / 645

Location

United States

Related Subject Headings

  • Squamous Cell Carcinoma of Head and Neck
  • Otorhinolaryngology
  • Nivolumab
  • Myositis
  • Myasthenia Gravis
  • Male
  • Humans
  • Head and Neck Neoplasms
  • Antineoplastic Agents, Immunological
  • Aged
 

Citation

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ICMJE
MLA
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Kang, K. H., Grubb, W., Sawlani, K., Gibson, M. K., Hoimes, C. J., Rogers, L. R., … Yao, M. (2018). Immune checkpoint-mediated myositis and myasthenia gravis: A case report and review of evaluation and management. Am J Otolaryngol, 39(5), 642–645. https://doi.org/10.1016/j.amjoto.2018.06.003
Kang, Kylie H., William Grubb, Komal Sawlani, Michael K. Gibson, Christopher J. Hoimes, Lisa R. Rogers, Pierre Lavertu, and Min Yao. “Immune checkpoint-mediated myositis and myasthenia gravis: A case report and review of evaluation and management.Am J Otolaryngol 39, no. 5 (2018): 642–45. https://doi.org/10.1016/j.amjoto.2018.06.003.
Kang KH, Grubb W, Sawlani K, Gibson MK, Hoimes CJ, Rogers LR, et al. Immune checkpoint-mediated myositis and myasthenia gravis: A case report and review of evaluation and management. Am J Otolaryngol. 2018;39(5):642–5.
Kang, Kylie H., et al. “Immune checkpoint-mediated myositis and myasthenia gravis: A case report and review of evaluation and management.Am J Otolaryngol, vol. 39, no. 5, 2018, pp. 642–45. Pubmed, doi:10.1016/j.amjoto.2018.06.003.
Kang KH, Grubb W, Sawlani K, Gibson MK, Hoimes CJ, Rogers LR, Lavertu P, Yao M. Immune checkpoint-mediated myositis and myasthenia gravis: A case report and review of evaluation and management. Am J Otolaryngol. 2018;39(5):642–645.
Journal cover image

Published In

Am J Otolaryngol

DOI

EISSN

1532-818X

Publication Date

2018

Volume

39

Issue

5

Start / End Page

642 / 645

Location

United States

Related Subject Headings

  • Squamous Cell Carcinoma of Head and Neck
  • Otorhinolaryngology
  • Nivolumab
  • Myositis
  • Myasthenia Gravis
  • Male
  • Humans
  • Head and Neck Neoplasms
  • Antineoplastic Agents, Immunological
  • Aged