Abdeljabbar Nadine A, Genovese Sabrina, Haradwala Mohamed B, Sivaraman Manjamalai
Department of Neurology, University of Missouri School of Medicine, Columbia, USA.
Cureus. 2024 Nov 11;16(11):e73444. doi: 10.7759/cureus.73444. eCollection 2024 Nov.
Pembrolizumab (Keytruda), an immune checkpoint inhibitor, has been increasingly utilized in the treatment of metastatic urothelial carcinoma. While offering a favorable safety profile compared to traditional chemotherapy, it presents unique risks, including immune-related adverse events (irAEs). This case report describes a 77-year-old woman with a history of invasive bladder cancer treated with pembrolizumab who developed severe bilateral ptosis, myositis, and myocarditis. Initially considered to have 3M syndrome, further evaluation indicated a myasthenia gravis mimic. This report emphasizes the critical need for vigilant monitoring for early signs of irAEs, such as ptosis, myocarditis, and myositis, in patients receiving pembrolizumab. The patient presented with severe ptosis and respiratory difficulties and was successfully treated with high-dose steroids and plasma exchange therapy, leading to overall improvement. This case highlights the diagnostic challenges of differentiating myositis from myasthenia gravis in patients with ICI-induced complications while advocating for an aggressive treatment approach.
帕博利珠单抗（可瑞达）是一种免疫检查点抑制剂，已越来越多地用于治疗转移性尿路上皮癌。与传统化疗相比，它具有良好的安全性，但也存在独特的风险，包括免疫相关不良事件（irAE）。本病例报告描述了一名77岁有浸润性膀胱癌病史且接受帕博利珠单抗治疗的女性，她出现了严重的双侧上睑下垂、肌炎和心肌炎。最初被认为患有3M综合征，进一步评估显示为重症肌无力样表现。本报告强调，对于接受帕博利珠单抗治疗的患者，密切监测irAE的早期迹象（如上睑下垂、心肌炎和肌炎）至关重要。该患者出现严重上睑下垂和呼吸困难，经大剂量类固醇和血浆置换治疗后成功治愈，整体情况得到改善。本病例突出了在ICI诱导并发症患者中区分肌炎和重症肌无力的诊断挑战，同时提倡积极的治疗方法。
