title: Myasthenia Gravis After Nivolumab Therapy for Squamous Cell Carcinoma of the Bladder.
abstract: Checkpoint inhibitors have become standard therapy for multiple cancers, and their use will increase in the next year as regulatory approvals for additional indications are expected. It is essential for clinicians to be aware of the potential for rare immune-related adverse effects. Here, we report the case of a new diagnosis of myasthenia gravis (MG) after the use of nivolumab for squamous cell carcinoma of the bladder. A review the literature identified 10 cases of MG diagnosed after programmed cell death protein 1 inhibitor therapy. This is the first case, to our knowledge, reported in association with bladder cancer. The precise diagnosis of MG has important implications on management, as treatment with steroids can transiently worsen myasthenia in nearly 50% of cases.
authors.affiliation: *Department of Medicine, Section of Hematology Oncology, Baylor College of Medicine, Houston, TX †Department of Hematology and Oncology at Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
authors.forename: Elaine
authors.initials: E
authors.lastname: Chang
authors.forename: Anita L
authors.initials: AL
authors.lastname: Sabichi
authors.forename: Yvonne H
authors.initials: YH
authors.lastname: Sada
mesh_terms: D000368:Aged; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D000074322:Antineoplastic Agents, Immunological / Q000009:adverse effects / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy*; D004172:Diplopia; D064420:Drug-Related Side Effects and Adverse Reactions / Q000175:diagnosis*; D004417:Dyspnea; D017809:Fatal Outcome; D006801:Humans; D007167:Immunotherapy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D009157:Myasthenia Gravis / Q000175:diagnosis*; D000077594:Nivolumab; D061026:Programmed Cell Death 1 Receptor / Q000276:immunology*; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy*
chemical_list: D000911:Antibodies, Monoclonal; D000074322:Antineoplastic Agents, Immunological; C105992:PDCD1 protein, human; D061026:Programmed Cell Death 1 Receptor; D000077594:Nivolumab