PMID- 32685327
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20200928
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 12
IP  - 7
DP  - 2020 Jul 14
TI  - Pembrolizumab-Induced Ocular Myasthenic Crisis.
PG  - e9192
LID - 10.7759/cureus.9192 [doi]
LID - e9192
AB  - Pembrolizumab, one of many novel immune checkpoint inhibitors (ICPi), is a 
      monoclonal antibody that enhances immunity against cancer cells. Extensive 
      escalation in immune activity predisposes to unsought immune-related adverse 
      events. Due to progressive mesothelioma, a 67-year-old man was referred to the 
      research unit and enrolled in a clinical trial with a cluster of differentiation 
      (CD) 27 chemotherapeutic agent. He began crossover treatment and received just 
      two doses of pembrolizumab, 33 and 16 days prior to admission. He subsequently 
      presented to the emergency department with three days of acute onset severe 
      diplopia and a drooping left eye. Acetylcholine receptor (AChR) antibodies 
      returned positive at 13.9 nmol/L, and a diagnosis of ocular myasthenia gravis 
      (OMG) was made. During his hospitalization, the patient was managed with 
      methylprednisolone 80 mg intravenously daily, with conversion to prednisone 60 mg 
      by mouth daily at time of discharge. Neuro-ophthalmology consultation was sought 
      in the outpatient setting, and the patient was started on pyridostigmine. He was 
      readmitted two weeks later with symptoms of progressive diffuse weakness, 
      unsteady gait, and dysphagia, all in the setting of persistent diplopia. 
      Intravenous immunoglobulin (IVIG) was promptly initiated, in addition to the 
      pyridostigmine previously initiated in the outpatient setting. Unfortunately, 
      after three IVIG treatments, the patient had experienced little improvement in 
      his symptoms, and therefore elected hospice care. Although ICPis have 
      revolutionized the management of a multitude of malignancies, recognition of 
      immune-related adverse events is of critical importance.
CI  - Copyright (c) 2020, Lorenzo et al.
FAU - Lorenzo, Christian J
AU  - Lorenzo CJ
AD  - Internal Medicine, Sarasota Memorial Hospital, Florida State University College 
      of Medicine, Sarasota, USA.
FAU - Fitzpatrick, Haley
AU  - Fitzpatrick H
AD  - Pharmacy, Sarasota Memorial Hospital, Sarasota, USA.
FAU - Campdesuner, Victoria
AU  - Campdesuner V
AD  - Internal Medicine, Sarasota Memorial Hospital, Florida State University College 
      of Medicine, Sarasota, USA.
FAU - George, Justin
AU  - George J
AD  - Internal Medicine, Sarasota Memorial Hospital, Florida State University College 
      of Medicine, Sarasota, USA.
FAU - Lattanzio, Natalia
AU  - Lattanzio N
AD  - Internal Medicine, Sarasota Memorial Hospital, Florida State University College 
      of Medicine, Sarasota, USA.
LA  - eng
PT  - Case Reports
DEP - 20200714
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC7366038
OTO - NOTNLM
OT  - anti-pd-1
OT  - diplopia
OT  - immune checkpoint inhibitor
OT  - keytruda
OT  - myasthenia gravis
OT  - myasthenic crisis
OT  - ocular
OT  - pembrolizumab
OT  - ptosis
COIS- The authors have declared that no competing interests exist.
EDAT- 2020/07/21 06:00
MHDA- 2020/07/21 06:01
PMCR- 2020/07/14
CRDT- 2020/07/21 06:00
PHST- 2020/07/21 06:00 [entrez]
PHST- 2020/07/21 06:00 [pubmed]
PHST- 2020/07/21 06:01 [medline]
PHST- 2020/07/14 00:00 [pmc-release]
AID - 10.7759/cureus.9192 [doi]
PST - epublish
SO  - Cureus. 2020 Jul 14;12(7):e9192. doi: 10.7759/cureus.9192.