Cargando…
Myositis-myasthenia gravis overlap syndrome complicated with myasthenia crisis and myocarditis associated with anti-programmed cell death-1 (sintilimab) therapy for lung adenocarcinoma
Immune checkpoint inhibitors (ICIs) have improved clinical outcomes with a number of advanced malignancies. However, diverse immune-related adverse events (iRAEs) occurred with the widespread use of ICIs, some of which are rarely and life-threatening. Here we report a 66-year-old patient with lung a...
Autores principales: | , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
AME Publishing Company
2020
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7154453/ https://www.ncbi.nlm.nih.gov/pubmed/32309397 http://dx.doi.org/10.21037/atm.2020.01.79 |
_version_ | 1783521821119741952 |
---|---|
author | Xing, Qian Zhang, Zhong-Wei Lin, Qiong-Hua Shen, Li-Hua Wang, Peng-Mei Zhang, Shan Fan, Ming Zhu, Biao |
author_facet | Xing, Qian Zhang, Zhong-Wei Lin, Qiong-Hua Shen, Li-Hua Wang, Peng-Mei Zhang, Shan Fan, Ming Zhu, Biao |
author_sort | Xing, Qian |
collection | PubMed |
description | Immune checkpoint inhibitors (ICIs) have improved clinical outcomes with a number of advanced malignancies. However, diverse immune-related adverse events (iRAEs) occurred with the widespread use of ICIs, some of which are rarely and life-threatening. Here we report a 66-year-old patient with lung adenocarcinoma who received two doses of sintilimab, a human monoclonal antibody against programmed cell death-1 (PD-1), experienced a fatal storm of iRAEs. He was admitted to the intensive care unit (ICU) by immune induced-myositis/myocarditis and rhabdomyolysis. Despite immediate immunosuppressive therapy with methylprednisolone (MP) and immunoglobulin intravenously, he developed into myositis-myasthenia gravis (MG) overlap syndrome complicated with myasthenia crisis. We commenced plasma exchange (PLEX), mechanical ventilation, immunosuppressive therapy, as well as other supportive therapies. Three months later, the patient’s serum creatine phosphate kinase (CPK) and anti-acetylcholine receptor antibody (anti-AChR-Ab) returned to normal despite tumor progression. Herein we discuss the incidence, operating mechanism and management strategies of the fatal iRAEs. Early admission to the ICU and multidisciplinary collaborative treatment for unstable patients with iRAEs could help to achieve a favorable outcome. |
format | Online Article Text |
id | pubmed-7154453 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | AME Publishing Company |
record_format | MEDLINE/PubMed |
spelling | pubmed-71544532020-04-17 Myositis-myasthenia gravis overlap syndrome complicated with myasthenia crisis and myocarditis associated with anti-programmed cell death-1 (sintilimab) therapy for lung adenocarcinoma Xing, Qian Zhang, Zhong-Wei Lin, Qiong-Hua Shen, Li-Hua Wang, Peng-Mei Zhang, Shan Fan, Ming Zhu, Biao Ann Transl Med Case Report Immune checkpoint inhibitors (ICIs) have improved clinical outcomes with a number of advanced malignancies. However, diverse immune-related adverse events (iRAEs) occurred with the widespread use of ICIs, some of which are rarely and life-threatening. Here we report a 66-year-old patient with lung adenocarcinoma who received two doses of sintilimab, a human monoclonal antibody against programmed cell death-1 (PD-1), experienced a fatal storm of iRAEs. He was admitted to the intensive care unit (ICU) by immune induced-myositis/myocarditis and rhabdomyolysis. Despite immediate immunosuppressive therapy with methylprednisolone (MP) and immunoglobulin intravenously, he developed into myositis-myasthenia gravis (MG) overlap syndrome complicated with myasthenia crisis. We commenced plasma exchange (PLEX), mechanical ventilation, immunosuppressive therapy, as well as other supportive therapies. Three months later, the patient’s serum creatine phosphate kinase (CPK) and anti-acetylcholine receptor antibody (anti-AChR-Ab) returned to normal despite tumor progression. Herein we discuss the incidence, operating mechanism and management strategies of the fatal iRAEs. Early admission to the ICU and multidisciplinary collaborative treatment for unstable patients with iRAEs could help to achieve a favorable outcome. AME Publishing Company 2020-03 /pmc/articles/PMC7154453/ /pubmed/32309397 http://dx.doi.org/10.21037/atm.2020.01.79 Text en 2020 Annals of Translational Medicine. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) . |
spellingShingle | Case Report Xing, Qian Zhang, Zhong-Wei Lin, Qiong-Hua Shen, Li-Hua Wang, Peng-Mei Zhang, Shan Fan, Ming Zhu, Biao Myositis-myasthenia gravis overlap syndrome complicated with myasthenia crisis and myocarditis associated with anti-programmed cell death-1 (sintilimab) therapy for lung adenocarcinoma |
title | Myositis-myasthenia gravis overlap syndrome complicated with myasthenia crisis and myocarditis associated with anti-programmed cell death-1 (sintilimab) therapy for lung adenocarcinoma |
title_full | Myositis-myasthenia gravis overlap syndrome complicated with myasthenia crisis and myocarditis associated with anti-programmed cell death-1 (sintilimab) therapy for lung adenocarcinoma |
title_fullStr | Myositis-myasthenia gravis overlap syndrome complicated with myasthenia crisis and myocarditis associated with anti-programmed cell death-1 (sintilimab) therapy for lung adenocarcinoma |
title_full_unstemmed | Myositis-myasthenia gravis overlap syndrome complicated with myasthenia crisis and myocarditis associated with anti-programmed cell death-1 (sintilimab) therapy for lung adenocarcinoma |
title_short | Myositis-myasthenia gravis overlap syndrome complicated with myasthenia crisis and myocarditis associated with anti-programmed cell death-1 (sintilimab) therapy for lung adenocarcinoma |
title_sort | myositis-myasthenia gravis overlap syndrome complicated with myasthenia crisis and myocarditis associated with anti-programmed cell death-1 (sintilimab) therapy for lung adenocarcinoma |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7154453/ https://www.ncbi.nlm.nih.gov/pubmed/32309397 http://dx.doi.org/10.21037/atm.2020.01.79 |
work_keys_str_mv | AT xingqian myositismyastheniagravisoverlapsyndromecomplicatedwithmyastheniacrisisandmyocarditisassociatedwithantiprogrammedcelldeath1sintilimabtherapyforlungadenocarcinoma AT zhangzhongwei myositismyastheniagravisoverlapsyndromecomplicatedwithmyastheniacrisisandmyocarditisassociatedwithantiprogrammedcelldeath1sintilimabtherapyforlungadenocarcinoma AT linqionghua myositismyastheniagravisoverlapsyndromecomplicatedwithmyastheniacrisisandmyocarditisassociatedwithantiprogrammedcelldeath1sintilimabtherapyforlungadenocarcinoma AT shenlihua myositismyastheniagravisoverlapsyndromecomplicatedwithmyastheniacrisisandmyocarditisassociatedwithantiprogrammedcelldeath1sintilimabtherapyforlungadenocarcinoma AT wangpengmei myositismyastheniagravisoverlapsyndromecomplicatedwithmyastheniacrisisandmyocarditisassociatedwithantiprogrammedcelldeath1sintilimabtherapyforlungadenocarcinoma AT zhangshan myositismyastheniagravisoverlapsyndromecomplicatedwithmyastheniacrisisandmyocarditisassociatedwithantiprogrammedcelldeath1sintilimabtherapyforlungadenocarcinoma AT fanming myositismyastheniagravisoverlapsyndromecomplicatedwithmyastheniacrisisandmyocarditisassociatedwithantiprogrammedcelldeath1sintilimabtherapyforlungadenocarcinoma AT zhubiao myositismyastheniagravisoverlapsyndromecomplicatedwithmyastheniacrisisandmyocarditisassociatedwithantiprogrammedcelldeath1sintilimabtherapyforlungadenocarcinoma |