Acetylcholine receptor binding antibody-associated myasthenia gravis and rhabdomyolysis induced by nivolumab in a patient with melanoma.
We reported an 81-year-old woman with metastatic melanoma, in whom myasthenia gravis and rhabdomyolysis developed after nivolumab monotherapy. The first symptom of myasthenia gravis was dyspnea. Ultrasonography detected hypokinesis of the bilateral diaphragm suggesting myasthenia gravis, although there was no abnormal finding of the lungs in computed tomography images. Acetylcholine receptor binding antibodies were low-titer positive in the preserved serum before administration of nivolumab, strongly suggesting that the myasthenia gravis was a nivolumab-related immune adverse event. Despite the remarkable clinical benefits of immune checkpoint inhibitors for patients with advanced melanoma, it is important to recognize unexpected immune-related adverse events.
Department of Dermatology, Shinshu University School of Medicine, Matsumoto.
Takushi
T
Shirai
Department of Dermatology, Shinshu University School of Medicine, Matsumoto.
Tasuku
T
Sano
Department of Dermatology, Shinshu University School of Medicine, Matsumoto.
Fuminao
F
Kamijo
Department of Dermatology, Shinshu University School of Medicine, Matsumoto.
Nana
N
Saito
Department of Dermatology, Shinshu University School of Medicine, Matsumoto.
Tomomi
T
Miyake
Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto.
Minori
M
Kodaira
Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto.
Nagaaki
N
Katoh
First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
Kenichi
K
Nishie
Department of Dermatology, Shinshu University School of Medicine, Matsumoto.
Ryuhei
R
Okuyama
Department of Dermatology, Shinshu University School of Medicine, Matsumoto uhara@shinshu-u.ac.jp.
Hisashi
H
Uhara
D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects*; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001323:Autoantibodies / Q000097:blood*; D005260:Female; D006801:Humans; D008545:Melanoma / Q000188:drug therapy; D009157:Myasthenia Gravis / Q000139:chemically induced* / Q000276:immunology; D000077594:Nivolumab; D011950:Receptors, Cholinergic / Q000276:immunology*; D012206:Rhabdomyolysis / Q000139:chemically induced* / Q000276:immunology; D012878:Skin Neoplasms / Q000188:drug therapy*
D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents; D001323:Autoantibodies; D011950:Receptors, Cholinergic; D000077594:Nivolumab
PD-1; melanoma; myasthenia gravis; nivolumab; rhabdomyolysis