発症 1 年後の抗横紋筋抗体を追跡し得た免疫チェックポイント阻害薬に関連した筋炎合併重症筋無力症の 1 例

Translated title of the contribution: Immune checkpoint inhibitor-induced anti-striational antibodies in myasthenia gravis and myositis: A case report

Yukio Sugiyama, Yoshiki Esa, Akihiro Watanabe, Junya Kobayashi, Shigeaki Suzuki, Daisuke Takahashi

Research output: Contribution to journalArticlepeer-review

Abstract

A 78-year-old man was treated with ipilimumab and nivolumab for advanced renal cell carcinoma with liver and lymph node metastasis. He developed diplopia, ptosis, dysphagia, and weakness of the limbs and neck, 1 month after treatment. Serum creatine kinase (CK) levels were elevated, and neck MRI revealed inflammation of the deep trunk muscles. Although anti-acetylcholine receptor antibody was negative, the edrophonium test was positive. Anti-striational antibodies such as the anti-titin and the anti-muscular voltage-gated potassium channel (Kv 1.4) antibodies (which serve as biomarkers of immune checkpoint inhibitors associated with myasthenia gravis and myositis) were positive (anti-titin antibody titer 11.51, normal <1 index; anti-Kv 1.4 antibody titer 15.13, normal <1 index). Intravenous methylprednisolone pulse therapy (1,000 mg/day for 3 days), plasmapheresis, and oral prednisolone (PSL) (20 mg/day) administration improved the patient's neurological function and normalized the serum CK levels. The PSL dosage was tapered without any worsening of clinical signs. The antibody titers decreased but remained positive (anti-titin antibody 5.00, anti-Kv 1.4 antibody 3.83) one year after the initial evaluation. Therefore, low-dose PSL (5 mg/day) administration was continued, and the patient was in remission.

Translated title of the contributionImmune checkpoint inhibitor-induced anti-striational antibodies in myasthenia gravis and myositis: A case report
Original languageJapanese
Pages (from-to)630-634
Number of pages5
JournalClinical Neurology
Volume61
Issue number9
DOIs
Publication statusPublished - 2021

ASJC Scopus subject areas

  • Clinical Neurology

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