Takai Manabu, Kato Daiki, Iinuma Koji, Maekawa Yuka Muramatsu, Nakane Keita, Tsuchiya Tomohiro, Yokoi Shigeaki, Koie Takuya
Department of Urology, Gifu University Graduate School of Medicine, Gifu, 501-1194, Japan.
Department of Urology, Kizawa Memorial Hospital, Minokamo, 505-8503, Japan.
Urol Case Rep. 2020 Feb 26;31:101145. doi: 10.1016/j.eucr.2020.101145. eCollection 2020 Jul.
We report a fatal case of pembrolizumab-induced myasthenia gravis and myocarditis in a patient with metastatic bladder cancer. A 77-year-old man was aware of eye ptosis and diplopia after three weeks from first infusion of pembrolizumab, an anti-programmed cell death protein 1 monoclonal antibodies. He was diagnosed with myasthenia gravis, because he was positive on the edrophonium test and acetylcholine receptor antibody. As his echocardiography also revealed diffuse loss in wall motion with ejection fraction 29%, he was strongly suspected myocarditis. Although he was treated with prednisone and intravenous immunoglobulin, he was suddenly in cardiac arrest and passed away.
我们报告了一例转移性膀胱癌患者因帕博利珠单抗诱发重症肌无力和心肌炎导致死亡的病例。一名77岁男性在首次输注抗程序性细胞死亡蛋白1单克隆抗体帕博利珠单抗三周后出现眼睑下垂和复视。他被诊断为重症肌无力，因为依酚氯铵试验和乙酰胆碱受体抗体呈阳性。由于他的超声心动图还显示室壁运动弥漫性减弱，射血分数为29%，故高度怀疑心肌炎。尽管他接受了泼尼松和静脉注射免疫球蛋白治疗，但仍突然心脏骤停并死亡。
