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Shibuya R, Baba K, Furuta R, Maesaka H, Hirosawa H, Bando T, Oshima A, Onoda H, Nukui T, Dougu N, Joho S, Nakatsuji Y. A Case of Liver Cancer with Overlapping Myasthenia Gravis, Myocarditis, Seronegative Autoimmune Autonomic Ganglionopathy, and Myositis Symptoms Induced by Atezolizumab: A Case Report. Intern Med 2024:1801-23. [PMID: 38171860 DOI: 10.2169/internalmedicine.1801-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Abstract
An 83-year-old man with hepatocellular carcinoma developed muscle weakness, ptosis, and dyspnea 3 weeks after receiving atezolizumab. Soon after, mechanical ventilation was initiated, which was followed by marked blood pressure spikes. The levels of creatine kinase and troponin-I were significantly elevated, and acetylcholine receptor antibodies were positive. The patient was diagnosed with immune checkpoint inhibitor (ICI)-induced myositis, myasthenia gravis (MG), myocarditis, and suspected autoimmune autonomic ganglionopathy (AAG). After immunotherapy, the serum markers and blood pressure normalized, and he was weaned from the ventilator after five months. To our knowledge, this is the first reported case of AAG secondary to ICI-induced myositis, MG, and myocarditis.
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Affiliation(s)
- Ryoko Shibuya
- Department of Neurology, Faculty of Medicine, University of Toyama, Japan
| | - Kousuke Baba
- Department of Neurology, Faculty of Medicine, University of Toyama, Japan
| | - Risako Furuta
- Department of Neurology, Faculty of Medicine, University of Toyama, Japan
| | - Hiroki Maesaka
- Department of Neurology, Faculty of Medicine, University of Toyama, Japan
| | - Hiroaki Hirosawa
- Department of Neurology, Faculty of Medicine, University of Toyama, Japan
| | - Tadashi Bando
- Department of Surgery, Saiseikai Toyama Hospital, Japan
| | - Akira Oshima
- Second Department of Internal Medicine, Faculty of Medicine, University of Toyama, Japan
| | - Hiroshi Onoda
- Second Department of Internal Medicine, Faculty of Medicine, University of Toyama, Japan
| | - Takamasa Nukui
- Department of Neurology, Faculty of Medicine, University of Toyama, Japan
| | - Nobuhiro Dougu
- Department of Neurology, Faculty of Medicine, University of Toyama, Japan
| | - Shuji Joho
- Second Department of Internal Medicine, Faculty of Medicine, University of Toyama, Japan
| | - Yuji Nakatsuji
- Department of Neurology, Faculty of Medicine, University of Toyama, Japan
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