Lethal Immune Myocarditis and Myasthenia Gravis Due to Anti-PD-1 Treatment for a Bladder Cancer Patient: A Case Report and Possible Treatment Inspiration

Abstract

Immune checkpoint inhibitors (ICI) have become a new hope for many patients with advanced cancer by blocking tumor immune escape. Bladder cancer is a common malignant tumor of the urinary tract epithelium that often relapses and metastasizes after surgery, chemotherapy, and radiotherapy. Immunotherapy has dramatically improved patient survival rates and clinical benefits as a new, potentially effective therapy. However, avoidance of various immune-related adverse events (irAEs) remains an implausible idea. ICI-induced myocarditis is different from viral myocarditis, and mortality is still high with the current treatment. We report the case of an 82-year-old female patient with ICI-induced fulminant myocarditis and myasthenia gravis. Although she actively accepted the current mainstream treatment for immune-related myocarditis and myasthenia, she died of heart and respiratory failure. Analyzing and reporting the patient’s disease development process and the changes in related indicators may help peers gain a deeper understanding of immune-related adverse events and reduce the mortality of immune-related myocarditis.

Keywords:

• immune checkpoint inhibitors
• immunotherapy
• heart failure
• multiple organs failure

Ethical Statement and Consent to Participate

The publication of this case report obtained the verbal informed consent of the patient’s daughter, which was witnessed by a member of the research team and documented accordingly. The report excludes potential identifiers for patients. The institutional approval was not required to publish the case details.

Acknowledgments

We are incredibly appreciative to the patient’s daughter for enabling us to present the case.

Disclosure

The authors report no conflicts of interest in this work.