Background: Immune checkpoint inhibitor-induced (ICI) myasthenia gravis (MG) is rare but may present as a fulminant overlap syndrome with myositis and myocarditis. Case Presentation: A 63-year-old man with carcinoma of the oral cavity receiving Toripalimab presented with fluctuating ptosis, dysarthria, dysphagia, generalized weakness, and breathlessness. He developed type 2 respiratory failure requiring non-invasive ventilatory (NIV) support. Anti-AChR and anti-MuSK antibodies were negative, and RNST was non-decremental. Creatinine Kinase (CK), Serum Glutamic Pyruvic Transaminase (SGPT), and Serum Glutamic-Oxaloacetic Transaminase (SGOT) were elevated, supporting myositis. High-sensitivity troponin I, CPK-MB, and NT-proBNP were raised, supporting myocarditis overlap. Imaging excluded major alternate central and thromboembolic causes. He was treated with immunomodulatory therapies (intravenous methylprednisolone and immunoglobulin-IVIG). Conclusion: ICI-induced seronegative MG with myositis-myocarditis (MMM syndrome) overlap should be suspected in patients receiving PD-1 inhibitors who develop acute ocular-bulbar weakness and respiratory decline, even when antibody and electrophysiologic studies are negative. Early recognition is critical because... Continue Reading

Background: Purulent bacterial pericarditis is an exceptionally rare but rapidly progressive cause of acute pericarditis in the modern antibiotic and pneumococcal vaccination era. Despite its low incidence, delayed recognition carries a high risk of cardiac tamponade, septic shock, constrictive pericarditis, and death. Case Presentation: We report the case of a 64-year-old man with pulmonary and hepatic sarcoidosis and well-controlled human immunodeficiency virus (HIV) infection receiving highly active antiretroviral therapy with an undetectable viral load, who presented with pleuritic chest pain and progressive dyspnea. Initial evaluation demonstrated diffuse ST-segment elevations on electrocardiogram and a moderate pericardial effusion without tamponade physiology on transthoracic echocardiography. Computed tomography revealed multifocal pneumonia, prompting empiric antimicrobial therapy. Despite initial management, the patient rapidly deteriorated with hypotension and acute hypoxic respiratory failure. Repeat echocardiography demonstrated evolving cardiac tamponade, necessitating emergent pericardiocentesis. Blood cultures and pericardial fluid cultures both yielded Streptococcus pneumoniae, confirming purulent pneumococcal pericarditis and allowing... Continue Reading