"Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has."

Margaret Mead
Case report
peer-reviewed

Myasthenia Gravis Induced by Nivolumab: A Case Report



Abstract

Nivolumab is a programmed cell death receptor (PD-1) inhibitor therapy for aggressive cancers; however, it poses a risk of immune-related adverse side effects. We present a 73-year-old male with renal cell carcinoma who developed myasthenia gravis (MG) after being treated with nivolumab, proven by acetylcholine receptor antibodies. Our patient presented with symptoms of fatigue and upper and lower extremity weakness, eventually resulting in respiratory failure as a result of MG. Nivolumab is an emerging therapy for advanced cancers but poses severe immune-related adverse events. Clinicians using PD-1 inhibitors should have a high index of suspicion of autoimmune diseases so that early discontinuation and treatment can be established to limit long-term morbidity and mortality.



Want to read more?

Create a free account to continue reading this article.

Already a member? Login.



Case report
peer-reviewed

Myasthenia Gravis Induced by Nivolumab: A Case Report


Author Information

Jeet J. Mehta Corresponding Author

Internal Medicine/pediatrics, University of Kansas School of Medicine - Wichita

Eamon Maloney

Medicine/pediatrics, University of Kansas School of Medicine - Wichita

Sachin Srinivasan

Internal Medicine, University of Kansas School of Medicine - Wichita

Patrick Seitz

Internal Medicine, University of Kansas School of Medicine - Wichita

Michael Cannon

Cancer Center of Kansas, University of Kansas School of Medicine - Wichita


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.


Case report
peer-reviewed

Myasthenia Gravis Induced by Nivolumab: A Case Report


Figures etc.

Share
Case report
peer-reviewed

Myasthenia Gravis Induced by Nivolumab: A Case Report

Jeet J. Mehta">Jeet J. Mehta , Eamon Maloney">Eamon Maloney, Sachin Srinivasan">Sachin Srinivasan, Patrick Seitz">Patrick Seitz, Michael Cannon">Michael Cannon

  • Author Information
    Jeet J. Mehta Corresponding Author

    Internal Medicine/pediatrics, University of Kansas School of Medicine - Wichita

    Eamon Maloney

    Medicine/pediatrics, University of Kansas School of Medicine - Wichita

    Sachin Srinivasan

    Internal Medicine, University of Kansas School of Medicine - Wichita

    Patrick Seitz

    Internal Medicine, University of Kansas School of Medicine - Wichita

    Michael Cannon

    Cancer Center of Kansas, University of Kansas School of Medicine - Wichita


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

    Acknowledgements


    Article Information

    Published: September 20, 2017

    DOI

    10.7759/cureus.1702

    Cite this article as:

    Mehta J J, Maloney E, Srinivasan S, et al. (September 20, 2017) Myasthenia Gravis Induced by Nivolumab: A Case Report. Cureus 9(9): e1702. doi:10.7759/cureus.1702

    Publication history

    Received by Cureus: September 12, 2017
    Peer review began: September 15, 2017
    Peer review concluded: September 16, 2017
    Published: September 20, 2017

    Copyright

    © Copyright 2017
    Mehta et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Nivolumab is a programmed cell death receptor (PD-1) inhibitor therapy for aggressive cancers; however, it poses a risk of immune-related adverse side effects. We present a 73-year-old male with renal cell carcinoma who developed myasthenia gravis (MG) after being treated with nivolumab, proven by acetylcholine receptor antibodies. Our patient presented with symptoms of fatigue and upper and lower extremity weakness, eventually resulting in respiratory failure as a result of MG. Nivolumab is an emerging therapy for advanced cancers but poses severe immune-related adverse events. Clinicians using PD-1 inhibitors should have a high index of suspicion of autoimmune diseases so that early discontinuation and treatment can be established to limit long-term morbidity and mortality.



Want to read more?

Create a free account to continue reading this article.

Already a member? Login.



Jeet J. Mehta, M.D., Resident Physician

Internal Medicine/pediatrics, University of Kansas School of Medicine - Wichita

For correspondence:
jmehta2@kumc.edu

Eamon Maloney

Medicine/pediatrics, University of Kansas School of Medicine - Wichita

Sachin Srinivasan

Internal Medicine, University of Kansas School of Medicine - Wichita

Patrick Seitz

Internal Medicine, University of Kansas School of Medicine - Wichita

Michael Cannon

Cancer Center of Kansas, University of Kansas School of Medicine - Wichita

Jeet J. Mehta, M.D., Resident Physician

Internal Medicine/pediatrics, University of Kansas School of Medicine - Wichita

For correspondence:
jmehta2@kumc.edu

Eamon Maloney

Medicine/pediatrics, University of Kansas School of Medicine - Wichita

Sachin Srinivasan

Internal Medicine, University of Kansas School of Medicine - Wichita

Patrick Seitz

Internal Medicine, University of Kansas School of Medicine - Wichita

Michael Cannon

Cancer Center of Kansas, University of Kansas School of Medicine - Wichita