Wang Yu, Sun Zhichang, Wang Xue, Liu Funan, Wu Ying, Wei Qiaochu, Duan Shijie
Department of Oncology, Panjin Central Hospital, Panjin, Liaoning 124000, P.R. China.
Department of Oncology, The First Hospital of China Medical University, Shenyang, Liaoning 124000, P.R. China.
Exp Ther Med. 2024 Sep 11;28(5):426. doi: 10.3892/etm.2024.12715. eCollection 2024 Nov.
The treatment strategy of patients with locally advanced gastric cancer has undergone notable changes since immune checkpoint inhibitors (ICIs) were developed. Although ICIs are generally well-tolerated, they can also cause serious adverse events, such as autoimmune diseases. In patients with gastric cancer and without a history of immune disease, the incidence of myasthenia gravis combined with myocarditis caused by ICI treatment is rare. Furthermore, cases of gastric cancer with ocular myasthenia gravis, without limb weakness or severe dyspnea, although with urination difficulties and symptoms of third-degree atrioventricular block have not been previously reported, to the best of our knowledge. The present study describes the case of a 72-year-old male patient with locally advanced gastric cancer that was treated with chemoimmunotherapy with oxaliplatin + tigio + sintilimab. At 19 days following only one cycle of therapy, the patient developed a left eyelid weakness and difficulty in urinating, as well as diplopia. At 5 days after the symptom of eyelid weakness, a third-degree atrioventricular block occurred. Hormone therapy, a temporary pacemaker and gamma-globulin therapy were administered, and the patient was discharged 1 month later with the resolution of myasthenia gravis and the atrioventricular block. At the final follow-up (1 month after discharge), the patient had a full recovery from myasthenia gravis and arrhythmias. Although some similar cases have been previously reported, the majority of patients with limb weakness and have eventually succumbed; moreover, clinical symptoms were identified at a late stage, and the disease evolution records were not detailed. Therefore, the present study describes the case of the patient and treatment strategy, also providing detailed laboratory indicators and clinical symptom evolution. This was performed with the aim to aid future research and the treatment of immune-related diseases.
自免疫检查点抑制剂（ICI）问世以来，局部晚期胃癌患者的治疗策略发生了显著变化。尽管ICI通常耐受性良好，但它们也可能引发严重的不良事件，如自身免疫性疾病。在无免疫疾病史的胃癌患者中，ICI治疗导致重症肌无力合并心肌炎的发生率很低。此外，据我们所知，此前尚未有过无肢体无力或严重呼吸困难，但伴有排尿困难和三度房室传导阻滞症状的胃癌合并眼肌型重症肌无力病例的报道。本研究描述了一名72岁局部晚期胃癌男性患者的病例，该患者接受了奥沙利铂+替吉奥+信迪利单抗的化疗免疫治疗。仅在一个疗程治疗后的第19天，患者出现左眼睑无力、排尿困难以及复视。在眼睑无力症状出现后的第5天，发生了三度房室传导阻滞。给予了激素治疗、临时起搏器和丙种球蛋白治疗，1个月后患者出院，重症肌无力和房室传导阻滞症状得到缓解。在最后一次随访（出院后1个月）时，患者的重症肌无力和心律失常完全康复。尽管此前已有一些类似病例报道，但大多数伴有肢体无力的患者最终死亡；此外，临床症状发现较晚，疾病进展记录也不详细。因此，本研究描述了该患者的病例及治疗策略，还提供了详细的实验室指标和临床症状演变情况。这样做的目的是为未来免疫相关疾病的研究和治疗提供帮助。
