免疫检查点抑制剂相关肌无力、肌炎和心肌病重叠综合征致致命性一例：在尿路上皮癌中的作用。
A Fatal Case of Immune Checkpoint Inhibitor-Mediated Myasthenia Gravis, Myositis, and Cardiomyopathy Overlap Syndrome in Urothelial Carcinoma.
机构信息
Department of Internal Medicine, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA.
Department of Hematology & Oncology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA.
出版信息
Cancer Rep (Hoboken). 2024 Jul;7(7):e2140. doi: 10.1002/cnr2.2140.
BACKGROUND
Immune checkpoint inhibitors (ICIs) have led to improved outcomes for many cancer types. However, their use can also precipitate immune-related adverse events (irAEs) that can affect any organ system. While irAEs are often mild, they rarely affect multiple organ systems concurrently and can be fatal.
CASE
We report a fatal case of myasthenia gravis, myositis, and cardiotoxicity overlap syndrome precipitated by the ICI pembrolizumab along with a brief review of available literature.
CONCLUSION
Early recognition of high grade irAEs and prompt intervention is essential. Despite the poor prognosis of these overlap syndromes, current recommendations offer little guidance for severe cases and warrant a call for increased awareness and expansion of available therapeutics.
背景
免疫检查点抑制剂（ICIs）已显著改善多种癌症类型的预后。然而，其应用也可诱发免疫相关不良事件（irAEs），影响任何器官系统。irAEs 通常较轻，但很少同时影响多个器官系统，且可能致命。
病例报告
我们报告了一例由 ICI 派姆单抗诱发的重症肌无力、肌炎和心肌毒性重叠综合征致死病例，并对现有文献进行了简要回顾。
结论
早期识别和干预高级别 irAEs 至关重要。尽管这些重叠综合征的预后较差，但现有建议几乎没有为重症病例提供指导，需要提高认识并扩大现有治疗方法。
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