1 例转移性胃癌患者使用纳武利尤单抗相关重症肌无力和心肌炎的罕见病例。
A rare case of nivolumab-related myasthenia gravis and myocarditis in a patient with metastatic gastric cancer.
机构信息
Department of Digestive Surgery, Niigata City General Hospital, Shumoku, Chuo-ku, Niigata, 463-7, Japan.
Department of Pathology, Niigata City General Hospital, Niigata, Japan.
出版信息
BMC Gastroenterol. 2021 Aug 26;21(1):333. doi: 10.1186/s12876-021-01904-4.
BACKGROUND
Although rare, several immune-related adverse effects can be life-threatening. Here, we describe a metastatic gastric cancer patient presenting with nivolumab-related myasthenia gravis and myocarditis, a previously unreported adverse effect of gastric cancer treatment.
CASE PRESENTATION
A 66-year-old man with metastatic gastric cancer visited the emergency department because of dizziness after the first dose of nivolumab. Diagnoses of nivolumab-related myasthenia gravis and myocarditis were established. Myocardial biopsy results and anti-acetylcholine receptor antibody positivity confirmed the diagnoses. Despite plasma exchange and intravenous methylprednisolone and immunoglobulin administration, the patient's general condition gradually worsened, and he died.
CONCLUSIONS
Strict monitoring for cardiac and neuromuscular symptoms after nivolumab administration is necessary to rapidly treat these adverse effects.
背景
虽然罕见，但一些免疫相关的不良反应可能危及生命。在这里，我们描述了一例转移性胃癌患者出现纳武利尤单抗相关重症肌无力和心肌炎，这是一种以前未报道过的胃癌治疗相关不良反应。
病例介绍
一名 66 岁男性，转移性胃癌患者，在接受纳武利尤单抗第一剂后因头晕而到急诊就诊。诊断为纳武利尤单抗相关重症肌无力和心肌炎。心肌活检结果和抗乙酰胆碱受体抗体阳性证实了这一诊断。尽管进行了血浆置换和静脉注射甲基强的松龙和免疫球蛋白治疗，但患者的一般情况逐渐恶化，最终死亡。
结论
纳武利尤单抗治疗后需要严格监测心脏和神经肌肉症状，以便迅速治疗这些不良反应。
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