scholarly journals A rare case of nivolumab-related myasthenia gravis and myocarditis in a patient with metastatic gastric cancer

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Masaru Komatsu ◽  
Motoharu Hirai ◽  
Kazuaki Kobayashi ◽  
Hideki Hashidate ◽  
Junki Fukumoto ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Adverse Effects ◽  
Myasthenia Gravis ◽  
Metastatic Gastric Cancer ◽  
Myocardial Biopsy ◽  
Case Presentation ◽  
Antibody Positivity ◽  
Life Threatening ◽  
Gastric Cancer Treatment ◽  
Anti Acetylcholine

Abstract Background Although rare, several immune-related adverse effects can be life-threatening. Here, we describe a metastatic gastric cancer patient presenting with nivolumab-related myasthenia gravis and myocarditis, a previously unreported adverse effect of gastric cancer treatment. Case presentation A 66-year-old man with metastatic gastric cancer visited the emergency department because of dizziness after the first dose of nivolumab. Diagnoses of nivolumab-related myasthenia gravis and myocarditis were established. Myocardial biopsy results and anti-acetylcholine receptor antibody positivity confirmed the diagnoses. Despite plasma exchange and intravenous methylprednisolone and immunoglobulin administration, the patient’s general condition gradually worsened, and he died. Conclusions Strict monitoring for cardiac and neuromuscular symptoms after nivolumab administration is necessary to rapidly treat these adverse effects.

“Mummy, my eyelids are heavy”: A case series of juvenile myasthenia gravis

2019 ◽  
pp. 112067211986760
Author(s):  
Logeswari Krishna ◽  
Nor Fadzillah Abdul Jalil ◽  
Pooi Wah Lott ◽  
Sujaya Singh ◽  
May May Choo
Keyword(s):  
Myasthenia Gravis ◽  
Case Series ◽  
Tertiary Centre ◽  
Ocular Symptoms ◽  
Ocular Myasthenia Gravis ◽  
Life Threatening ◽  
Receptor Antibodies ◽  
Juvenile Myasthenia Gravis ◽  
Anti Acetylcholine ◽  
Second Twin

Purpose: To report three cases of juvenile myasthenia gravis aged between 18 and 24 months with ocular symptoms as their first presentation. Method: A case series. Results: We present a case series of juvenile myasthenia gravis in a tertiary centre in Malaysia. Two of the three cases consist of a pair of twins who presented with ptosis of bilateral eyes; the first twin presented 4 months later than the second twin. These two cases were positive for anti-acetylcholine receptor antibodies and had generalized myasthenia gravis, whereas the other case was negative for receptor antibodies and was purely ocular myasthenia gravis. Conclusion: Juvenile myasthenia gravis is relatively rare in toddlers. Early diagnosis and commencement of treatment is important to slow the progression of the disease and avoiding life-threatening events.

scholarly journals Clinical and therapeutic features of myasthenia gravis in adults based on age at onset

Neurology ◽  
2020 ◽  
Vol 94 (11) ◽  
pp. e1171-e1180 ◽  
Author(s):  
Elena Cortés-Vicente ◽  
Rodrigo Álvarez-Velasco ◽  
Sonia Segovia ◽  
Carmen Paradas ◽  
Carlos Casasnovas ◽  
...  
Keyword(s):  
Myasthenia Gravis ◽  
Early Onset ◽  
Late Onset ◽  
Age At Onset ◽  
Neuromuscular Diseases ◽  
Cross Sectional ◽  
Life Threatening ◽  
Onset Group ◽  
Anti Acetylcholine

ObjectiveTo describe the characteristics of patients with very-late-onset myasthenia gravis (MG).MethodsThis observational cross-sectional multicenter study was based on information in the neurologist-driven Spanish Registry of Neuromuscular Diseases (NMD-ES). All patients were >18 years of age at onset of MG and onset occurred between 2000 and 2016 in all cases. Patients were classified into 3 age subgroups: early-onset MG (age at onset <50 years), late-onset MG (onset ≥50 and <65 years), and very-late-onset MG (onset ≥65 years). Demographic, immunologic, clinical, and therapeutic data were reviewed.ResultsA total of 939 patients from 15 hospitals were included: 288 (30.7%) had early-onset MG, 227 (24.2%) late-onset MG, and 424 (45.2%) very-late-onset MG. The mean follow-up was 9.1 years (SD 4.3). Patients with late onset and very late onset were more frequently men (p < 0.0001). Compared to the early-onset and late-onset groups, in the very-late-onset group, the presence of anti–acetylcholine receptor (anti-AChR) antibodies (p < 0.0001) was higher and fewer patients had thymoma (p < 0.0001). Late-onset MG and very-late-onset MG groups more frequently had ocular MG, both at onset (<0.0001) and at maximal worsening (p = 0.001). Although the very-late-onset group presented more life-threatening events (Myasthenia Gravis Foundation of America IVB and V) at onset (p = 0.002), they required fewer drugs (p < 0.0001) and were less frequently drug-refractory (p < 0.0001).ConclusionsPatients with MG are primarily ≥65 years of age with anti-AChR antibodies and no thymoma. Although patients with very-late-onset MG may present life-threatening events at onset, they achieve a good outcome with fewer immunosuppressants when diagnosed and treated properly.

scholarly journals A case report of disseminated nocardiosis with ocular involvement in myasthenia gravis patient and literature review

2019 ◽  
Author(s):  
shuhui wang ◽  
Bin Jiang ◽  
Yao Li ◽  
Yanchang Shang ◽  
Zhengshan Liu ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Myasthenia Gravis ◽  
Potential Risk ◽  
Immunosuppressive Agents ◽  
Ocular Involvement ◽  
Immunocompromised Patients ◽  
Case Presentation ◽  
Ocular Manifestations ◽  
Life Threatening ◽  
Disseminated Nocardiosis

Abstract Background Nocardiosis is a rare and life-threatening opportunistic infection in the immunocompromised patients. Myasthenia gravis (MG) patients have the potential risk of nocardia infection because of the use of immunosuppressive agents. To date, only 7 cases of patients with MG have been reported to have nocardiosis. Disseminated nocardiosis with ocular involvement in MG patient haven’t been reported. Case presentation A 66-year-old man with MG, receiving treatment of methylprednisolone and azathioprine, was found to have respiratory infection. He also had heterogeneous symptoms with skin, brain and ocular manifestations. Nocardia bacteria was verified by the culture of puncture fluid, and the diagnosis of disseminated nocardiosis was made. Except for the left eye blindness, the patient completely recovered from the disease with combination antibiotic therapy. To further understand nocardiosis in patients with MG, we reviewed previous relevant literatures. According to all the literatures, this is the first report of disseminated nocardiosis with ocular involvement in MG patient. Conclusions MG patients with immunosuppressant treatments have the potential risk of rare nocardia infection, and a favourable prognosis can be achieved through early diagnosis and appropriate antibiotic therapy.

scholarly journals Metastatic gastric cancer treatment: Second line and beyond

2016 ◽  
Vol 22 (11) ◽  
pp. 3069 ◽  
Author(s):  
Marwan Ghosn ◽  
Samer Tabchi ◽  
Hampig Raphael Kourie ◽  
Mustapha Tehfe
Keyword(s):  
Gastric Cancer ◽  
Cancer Treatment ◽  
Metastatic Gastric Cancer ◽  
Second Line ◽  
Gastric Cancer Treatment

scholarly journals Overview of Gastric Cancer Treatment and Recent Developments – An Updated Review

2020 ◽  
Vol 11 (1) ◽  
pp. 519-531
Author(s):  
Arun Kumar Vadikari ◽  
Akkihebbal R Akhila ◽  
Vishakante Gowda D ◽  
Mahendran Bhaskaran ◽  
Parthasarathi K Kulkarni ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Recurrent Disease ◽  
Intraperitoneal Administration ◽  
Health Issues ◽  
Curative Intent ◽  
First Choice ◽  
Recent Developments ◽  
Life Threatening ◽  
Treatment Concepts ◽  
Gastric Cancer Treatment

Gastric Cancer (GC) is one among the serious diseases prevailing globally. GC has immense global life-threatening health issues by taking 4th place among all the widespread cancers and 2nd foremost reason for fatality around the globe. Numerous patients have an inoperable disease at diagnosis or have recurrent disease after resection with curative intent. Surgery remains the principle therapy, while perioperative and adjuvant chemotherapy and chemoradiation can improve the outcome of GC therapy. Targeted therapies such as Trastuzumab, an antibody against HER2 and the VEGFR-2 antibody ramucirumab highly preferred in GC. Since the last few years, immunotherapy became a significant approach for the cure of various cancers like GC.  In the present review, we have put forward the various stages of GC and all the possible advanced treatments for GC. Surgery is still the first choice analysed in GC followed by chemotherapy and radiotherapy. New frontiers in treatment suggest the growing consideration for intraperitoneal administration of chemotherapeutics and a combination of traditional drugs with the newer generation. A note is added to relevant studies dealing with neoadjuvant and adjuvant treatment concepts and gives an overview of latest trends and developments in GC treatment

scholarly journals Systemic Inflammatory Reaction to Intravitreal Bevacizumab: A Case Report

2021 ◽  
Author(s):  
Samuel Burridge ◽  
Richard Stratton ◽  
Riaz Asaria
Keyword(s):  
Adverse Effects ◽  
Inflammatory Reaction ◽  
Intravitreal Bevacizumab ◽  
Case Presentation ◽  
Blood Tests ◽  
Bevacizumab Treatment ◽  
Systemic Inflammatory Reaction ◽  
Life Threatening ◽  
History Of ◽  
Systemic Side Effects

Abstract IntroductionTo present a case of systemic inflammatory reaction, with associated pleural and pericardial effusions, following intravitreal bevacizumab for retinal macroaneurysm. Case presentationA 73 year old female was commenced on monthly intravitreal bevacizumab injections for right eye macroaneurysm and associated macular oedema. Eight days following her third injection, the patient was admitted to hospital with a history of fever, rigors, arthralgia and vomiting. Admission blood tests demonstrated mild thrombocytopaenia and raised inflammatory markers. A CT chest revealed small pericardial and pleural effusions. The patient improved without treatment and was later discharged from hospital. As intravitreal bevacizumab treatment continued, the patient developed two further episodes of fever and vomiting, with both episodes occurring approximately nine days following each injection. The patient then underwent outpatient medical review by infectious disease and rheumatology specialists, at which time the recurrent episodes of systemic inflammation were diagnosed as secondary to intravitreal bevacizumab.ConclusionsThough rare, patients can develop serious and potentially life-threatening systemic adverse effects from intravitreal anti-VEGF treatment. Ophthalmologists should always enquire about systemic side effects; in this way, adverse effects may be recognised sooner and a change or cessation of therapy considered.

scholarly journals Durvalumab-induced myocarditis, myositis, and myasthenia gravis: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Jason Cham ◽  
Daniel Ng ◽  
Laura Nicholson
Keyword(s):  
Adverse Effects ◽  
Myasthenia Gravis ◽  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors ◽  
Small Cell ◽  
Small Cell Lung ◽  
Case Presentation ◽  
Progressive Dyspnea ◽  
Wide Range ◽  
New Onset

Abstract Background Immune checkpoint inhibitors are effective therapies for a wide range of malignancies. Their increased use has led to a wide range of immune-related adverse effects including skin, gastrointestinal, pulmonary, endocrine, cardiac, and neurologic complications. Case presentation We present the case of a 72-year-old Caucasian man with non-small cell lung cancer who was admitted for dyspnea after two cycles of durvalumab. He was found to have significantly elevated levels of serum creatinine kinase and troponin with a negative cardiac catheterization. During his hospitalization, he developed progressive dyspnea and new-onset axial weakness, ultimately leading to the diagnosis of durvalumab-induced myocarditis, myasthenia gravis, and myositis. Conclusion This is, to our knowledge, the first reported case of anti-programmed cell death ligand 1-induced combination of myocarditis, myasthenia gravis, and myositis. While the use of immunologic agents has resulted in overall improved cancer outcomes, their increased use has led to a vast spectrum of immune-related adverse effects. We review the diagnostic workup and management of patients with these immune-related adverse effects, underscoring the importance of early identification given the potential for rapid deterioration.

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