One Case of Immune Myocarditis Complicated with Severe Myasthenia Gravis Caused by Pembrolizumab Injection

doi:10.19803/j.1672-8629.20240961

Abstract

Abstract: Objective To explore one case of immune myocarditis complicated with myasthenia gravis caused by pabolizumab Injection so as to provide a reference for rational use of pabolizumab in clinic. Methods The diagnosis and treatment of one patient with autoimmune myocarditis complicated with myasthenia gravis due to lung adenocarcinoma and treated with pabolizumab were analyzed. Related literature was searched for to find out whether ICIs treatment could be restarted and what was the best coping strategy. Results The patient developed immune myocarditis complicated with myasthenia gravis about 6 weeks after pabolizumab was taken. After discontinuation of this drug and symptomatic treatment, cardiac troponin I decreased significantly and the symptoms of ocular myasthenia improved. It was found that immune myocarditis complicated with myasthenia gravis might occur following the use of pabolizumab, making it necessary to stop taking the drug and intervene as soon as possible. Conclusion Pabolizumab may lead to immune myocarditis complicated with myasthenia gravis, which deserves more attention.

Key words: Pembrolizumab Injection, Immune Checkpoint Inhibitors, Immune Myocarditis, Myasthenia Gravis, Adverse Drug Reaction, Lung Cancer

CLC Number:

CHEN Yali, ZHENG Xiaochun. One Case of Immune Myocarditis Complicated with Severe Myasthenia Gravis Caused by Pembrolizumab Injection[J]. Chinese Journal of Pharmacovigilance, 2026, 23(4): 464-466.

Add to citation manager EndNote|Ris|BibTeX

URL: https://zgywjj.magtechjournal.com/EN/10.19803/j.1672-8629.20240961

https://zgywjj.magtechjournal.com/EN/Y2026/V23/I4/464

References

[1] The Chinese Society of Clinical Oncology Expert Committee on Cardio-Oncology. Chinese Expert Consensus on the Surveillance and Management of Immune Checkpoint Inhibitor-Related Myocarditis(2020)[J]. Chin J Clin Oncol(中国肿瘤临床), 2020, 47(20): 1027-1038.
[2] THOMPSON JA, SCHNEIDER BJ, BRAHMER J, et al.NCCN Guidelines® Insights: Management of Immunotherapy-Related Toxicities, Version 2[J]. J Natl Compr Canc Netw, 2024, 22(9): 582-592.
[3] TAJIRI K, IEDA M.Cardiac Complications in Immune Checkpoint Inhibition Therapy[J]. Frontiers in Cardiovascular Medicine, 2019, 6: 3.
[4] HU Y, LIU C, JIN S, et al.A Case of Subclinical Immune Checkpoint Inhibitor-Associated Myocarditis in Non-Small Cell Lung Cancer[J]. BMC Pulmonary Medicine, 2023, 23(1): 119.
[5] DONG H, QI Y, KONG X, et al.PD-1/PD-L1 Inhibitor-Associated Myocarditis: Epidemiology, Characteristics, Diagnosis, Treatment, and Potential Mechanism[J]. Frontiers in Pharmacology, 2022, 13: 835510.
[6] WEI XB, YAN F.A Case Report of Myasthenia Gravis Combined with Immune-Associated Myocarditis after PD-1 Immunosuppressant Treatment[J]. Chinese Journal of Hospital Pharmacy(中国医院药学杂志), 2025, 45(11): 1321-1324.
[7] WU TX, ZHANG Y, SHI YF, et al.Immune Checkpoint Inhibitor-Associated Myositis, Myocarditis and Myasthenia Gravis Overlap Syndrome Based on the US FDA Adverse Event Reporting System[J].Central South Pharmacy(中南药学), 2023, 21(8): 2232-2237.
[8] LEI Y, ZHENG X, HUANG Q, et al.Intrinsic Differences in Immune Checkpoint Inhibitor-Induced Myocarditis: a Retrospective Analysis of Real World Data[J]. Frontiers in pharmacology, 2022, 13: 914928.
[9] TANG X, LI Y, HUANG H, et al.Early Evaluation of Severe Immune Checkpoint Inhibitor-Associated Myocarditis: a Real-World Clinical Practice[J]. Journal of Cancer Research and Clinical Oncology, 2023, 149(11): 8345-8357.
[10] PUZANOV I, SUBRAMANIAN P, YATSYNOVICH YV, et al.Clinical Characteristics, Time Course, Treatment and Outcomes of Patients with Immune Checkpoint Inhibitor-Associated Myocarditis[J]. Journal for Immunotherapy of Cancer, 2021, 9(6): e002553.
[11] CHEN JJ, QIAN PP, CAO K.Comparison and Analysis of Causality Assessment Method in China and Naranjo’s Method in the Evaluation of Adverse Drug Reactions[J]. Chinese Pharmaceutical Affairs(中国药事), 2020, 34(8): 988-992.
[12] HUANG YT, CHEN YP, LIN WC, et al.Immune Checkpoint Inhibitor-Induced Myasthenia Gravis[J]. Frontiers in Neurology, 2020, 11: 634.
[13] WU NC, FENG YH, KUO YH, et al.Clinical Features and Outcomes of Immune Checkpoint Inhibitor-Associated Cardiovascular Toxicities[J]. Acta Cardiologica Sinica, 2022, 38(1): 39-46.
[14] GAO JX, LIU XX, XIA H.Research Progress of Inhibitor Associated Myocarditisat Immune Checkpoint[J]. Chin J Diffic and ComplCas(疑难病杂志), 2022, 21(12): 1311-1319.
[15] LIU YL, HE ZY.Analysis of Pembrolizumab Associated Myasthenia Gravis Based on Literature Reviews[J]. Chinese Journal of Pharmacoe-pidemiology(药物流行病学杂志), 2022, 31(6): 421-426.
[16] ZUBAIR AS, ROY B, BAEHRING JM, et al.Myasthenia Gravis in the Setting of Immune Checkpoint Inhibitor Therapy: Practical Considerations and Opinion-Based Approach to Acute Management[J]. Cureus, 2022, 14(10): e30638.
[17] JOHNSON DB, MENZIES AM.Combination Immunomodulation for Immune-Checkpoint-Inhibitor-Associated Myocarditis[J]. Nature Reviews Clinical Oncology, 2023, 20(7): 427-428.
[18] MARCO C, SIMÓ M, ALEMANY M, et al.Myasthenia Gravis Induced by Immune Checkpoint Inhibitors: an Emerging Neurotoxicity in Neuro-Oncology Practice: Case Series[J]. Journal of Clinical Medicine, 2022, 12(1):130.
[19] PALASKAS NL, SEGURA A, LELENWA L, et al.Immune Checkpoint Inhibitor Myocarditis: Elucidating the Spectrum of Disease through Endomyocardial Biopsy[J]. European Journal of Heart Failure, 2021, 23(10): 1725-1735.
[20] WANG X, CHEN WY.Pharmaceutical Monitoring of Immunohepatitis Caused by PD-L1 Inhibitor: a Case Study[J]. Chinese Journal of Pharma-covigilance(中国药物警戒), 2021, 18(7): 693-696.