Liver Cancer with Overlapping Myasthenia Gravis, Myocarditis, Seronegative Autoimmune Autonomic Ganglionopathy, and Myositis Symptoms Induced by Atezolizumab

Ryoko Shibuya, Kosuke Baba*, Risako Furuta, Hiroki Maesaka, Hiroaki Hirosawa, Tadashi Bando, Akira Oshima, Hiroshi Onoda, Takamasa Nukui, Nobuhiro Dogu, Shuji Joho, Yuji Nakatsuji

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

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.

Original languageEnglish
Pages (from-to)2193-2198
Number of pages6
JournalInternal Medicine
Volume63
Issue number15
DOIs
StatePublished - 2024

Keywords

  • anti-striated muscle antibody
  • autoimmune autonomic ganglionopathy
  • immune checkpoint inhibitor
  • myasthenia gravis
  • myocarditis
  • myositis symptoms

ASJC Scopus subject areas

  • Internal Medicine

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