Key result
Single-dose nivolumab triggers fatal overlapping myocarditis and myasthenia gravis.
Why the study?
Nivolumab-related myasthenia gravis and myocarditis are rare but potentially fatal immune-related adverse effects, with no prior reports in metastatic gastric cancer patients.
Case Report (n=1)
No
Single nivolumab dose may trigger fatal myocarditis and myasthenia gravis; extends irAE spectrum but leaves open risk prediction in gastric cancer.
BACKGROUND: Although rare, several immune-related adverse effects can be life-threatening. Here, we describe a metastatic gastric cancer patient presenting with nivolumab-related myasthenia gravis and myocarditis, a previously unreported adverse effect of gastric cancer treatment. CASE PRESENTATION: A 66-year-old man with metastatic gastric cancer visited the emergency department because of dizziness after the first dose of nivolumab. Diagnoses of nivolumab-related myasthenia gravis and myocarditis were established. Myocardial biopsy results and anti-acetylcholine receptor antibody positivity confirmed the diagnoses. Despite plasma exchange and intravenous methylprednisolone and immunoglobulin administration, the patient's general condition gradually worsened, and he died. CONCLUSIONS: Strict monitoring for cardiac and neuromuscular symptoms after nivolumab administration is necessary to rapidly treat these adverse effects.
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Hirai et al. (2021) conducted a case report in Metastatic gastric cancer (n=1). Nivolumab was evaluated on Development of immune-related adverse effects (myasthenia gravis and myocarditis). A 66-year-old man with metastatic gastric cancer developed fatal myasthenia gravis and myocarditis after a single dose of nivolumab.
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