PMID- 31852868
OWN - NLM
STAT- MEDLINE
DCOM- 20200817
LR  - 20200817
IS  - 1882-0654 (Electronic)
IS  - 0009-918X (Linking)
VI  - 60
IP  - 1
DP  - 2020 Jan 30
TI  - [A case of myasthenia gravis developed during pembrolizumab administration, 
      suggesting an excitation-contraction connection disorder].
PG  - 37-40
LID - 10.5692/clinicalneurol.cn-001323 [doi]
AB  - The patient was a 50-year-old woman. Pembrolizumab was started for bladder cancer 
      recurrence. From the day after the second administration, ptosis, diplopia, 
      restriction of eye movement, muscle weakness, fatigue resistance, increase in 
      serum creatine kinase (CK) level, and muscle pain were observed. Tests for 
      anti-acetylcholine receptor (AChR) antibody and anti-muscle specific kinase 
      (MuSK) antibody were negative. Electrophysiological examination of the 
      neuromuscular junction showed negative results, and electromyography revealed no 
      myogenic changes. We considered that the immune checkpoint inhibitor caused 
      neuromuscular damage. The patient's symptoms were gradually improved by 
      immunotherapy, such as steroid and plasma exchange. In this case, tests for the 
      anti-titin antibody, an anti-striational antibody, were positive. We considered 
      that myasthenia gravis-like symptoms and serum CK level elevation might have been 
      caused by impairment of excitation-contraction coupling, and not the 
      neuromuscular junction.
FAU - Fukazawa, Ryosuke
AU  - Fukazawa R
AD  - Department of Neurology, Saiseikai Shiga Hospital.
FAU - Takezawa, Hidesato
AU  - Takezawa H
AD  - Department of Neurology, Saiseikai Shiga Hospital.
FAU - Tsuji, Yukiko
AU  - Tsuji Y
AD  - Department of Neurology, Kyoto Prefectural University of Medicine.
FAU - Noto, Yuichi
AU  - Noto Y
AD  - Department of Neurology, Kyoto Prefectural University of Medicine.
FAU - Banba, Masato
AU  - Banba M
AD  - Department of Urology, Saiseikai Shiga Hospital.
FAU - Fujii, Akihiro
AU  - Fujii A
AD  - Department of Neurology, Saiseikai Shiga Hospital.
LA  - jpn
PT  - Case Reports
PT  - Journal Article
DEP - 20191217
PL  - Japan
TA  - Rinsho Shinkeigaku
JT  - Rinsho shinkeigaku = Clinical neurology
JID - 0417466
RN  - 0 (Antibodies, Monoclonal, Humanized)
RN  - 9PHQ9Y1OLM (Prednisolone)
RN  - DPT0O3T46P (pembrolizumab)
SB  - IM
MH  - Administration, Oral
MH  - Antibodies, Monoclonal, Humanized/administration & dosage/*adverse effects
MH  - Female
MH  - Humans
MH  - Middle Aged
MH  - Myasthenia Gravis/*chemically induced/therapy
MH  - Plasma Exchange
MH  - Prednisolone/administration & dosage
MH  - Treatment Outcome
OTO - NOTNLM
OT  - excitation-contraction connection
OT  - myasthenia gravis
OT  - myositis
OT  - pembrolizumab
EDAT- 2019/12/20 06:00
MHDA- 2020/08/18 06:00
CRDT- 2019/12/20 06:00
PHST- 2019/12/20 06:00 [pubmed]
PHST- 2020/08/18 06:00 [medline]
PHST- 2019/12/20 06:00 [entrez]
AID - 10.5692/clinicalneurol.cn-001323 [doi]
PST - ppublish
SO  - Rinsho Shinkeigaku. 2020 Jan 30;60(1):37-40. doi: 
      10.5692/clinicalneurol.cn-001323. Epub 2019 Dec 17.