EJMCR |

Case Report

Volume: 7 | Issue: 5 | Published: May 01, 2023 | Pages: 104 - 109 | DOI: 10.24911/ejmcr/173-1669055719

Myositis-myasthenic overlap syndrome triggered by pembrolizumab in a melanoma patient: a case report and brief review of the literature

Authors: Margarida Carrolo , Sara Machado , Paulo Gomes , Andreia Chaves , Antonio Quintela

Article Info

Authors

Margarida Carrolo

Oncology Department, Hospital CUF Descobertas, Lisboa, Portugal

ORCID

Sara Machado

Neurology Department, Hospital CUF Descobertas, Lisboa, Portugal

Paulo Gomes

Intensive Care Unit, Hospital CUF Descobertas, Lisboa, Portugal

Andreia Chaves

Oncology Department, Hospital CUF Descobertas, Lisboa, Portugal

Antonio Quintela

Oncology Department, Hospital CUF Descobertas, Lisboa, Portugal.

Publication History

Received: November 21, 2022

Revised: March 21, 2023

Accepted: March 21, 2023

Published: May 01, 2023

Abstract

Background: In the era of precision medicine, immune checkpoint inhibitors (ICIs) have dramatically changed the therapeutic approach toward advanced cancers. Despite an undeniably therapeutic benefit, ICIs have unique and uncharted toxicities known as immune-related adverse events (irAEs). Case Presentation: We report a rare overlap syndrome of inflammatory and necrotizing myopathy with a superimposed myasthenia-like syndrome in a melanoma patient who had received the first dose of pembrolizumab 22 days before symptoms onset. The patient initially presented with muscle weakness and ptosis and rapidly progressed to tetraparesis, extrinsic ophthalmoplegia, dysarthria, dysphagia, and respiratory difficulty with a short-term need for non-invasive ventilation and nasogastric intubation. Transitory myocarditis was also diagnosed. One month after hospital discharge, the patient still exhibits mild dysarthria, dysphagia, and ptosis and needs walking assistance. Conclusion: Although rare, neuromuscular irAEs impose a notable burden on morbidity and even mortality. Early recognition of symptoms and prompt intervention are crucial for the management of immunotherapy-related toxicity.

Keywords: Immune checkpoint inhibitors, immune-related adverse events, pembrolizumab, metastatic melanoma, myosistis, myasthenic-like syndrome, green

Pubmed Style

Margarida Carrolo, Sara Machado, Paulo Gomes, Andreia Chaves, Antonio Quintela. Myositis-myasthenic overlap syndrome triggered by pembrolizumab in a melanoma patient: a case report and brief review of the literature. EJMCR. 2023; 01 (May 2023): 104-109. doi:10.24911/ejmcr/173-1669055719

Web Style

Margarida Carrolo, Sara Machado, Paulo Gomes, Andreia Chaves, Antonio Quintela. Myositis-myasthenic overlap syndrome triggered by pembrolizumab in a melanoma patient: a case report and brief review of the literature. https://ejmcr.com/articles/1055 [Access: December 04, 2024]. doi:10.24911/ejmcr/173-1669055719

AMA (American Medical Association) Style

Vancouver/ICMJE Style

Margarida Carrolo, Sara Machado, Paulo Gomes, Andreia Chaves, Antonio Quintela. Myositis-myasthenic overlap syndrome triggered by pembrolizumab in a melanoma patient: a case report and brief review of the literature. EJMCR. (2023), [cited December 04, 2024]; 01 (May 2023): 104-109. doi:10.24911/ejmcr/173-1669055719

Harvard Style

Margarida Carrolo, Sara Machado, Paulo Gomes, Andreia Chaves, Antonio Quintela (2023) Myositis-myasthenic overlap syndrome triggered by pembrolizumab in a melanoma patient: a case report and brief review of the literature. EJMCR, 01 (May 2023): 104-109. doi:10.24911/ejmcr/173-1669055719

Chicago Style

Margarida Carrolo, Sara Machado, Paulo Gomes, Andreia Chaves, Antonio Quintela. "Myositis-myasthenic overlap syndrome triggered by pembrolizumab in a melanoma patient: a case report and brief review of the literature." 01 (2023), 104-109. doi:10.24911/ejmcr/173-1669055719

MLA (The Modern Language Association) Style

Margarida Carrolo, Sara Machado, Paulo Gomes, Andreia Chaves, Antonio Quintela. "Myositis-myasthenic overlap syndrome triggered by pembrolizumab in a melanoma patient: a case report and brief review of the literature." 01.May 2023 (2023), 104-109. Print. doi:10.24911/ejmcr/173-1669055719

APA (American Psychological Association) Style

Margarida Carrolo, Sara Machado, Paulo Gomes, Andreia Chaves, Antonio Quintela (2023) Myositis-myasthenic overlap syndrome triggered by pembrolizumab in a melanoma patient: a case report and brief review of the literature. , 01 (May 2023), 104-109. doi:10.24911/ejmcr/173-1669055719