{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T05:51:48Z","timestamp":1791179508020,"version":"4.1.0"},"reference-count":41,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2016,5,19]],"date-time":"2016-05-19T00:00:00Z","timestamp":1463616000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2016,5,19]],"date-time":"2016-05-19T00:00:00Z","timestamp":1463616000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Muscle and Nerve"],"published-print":{"date-parts":[[2016,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    <jats:italic>Introduction<\/jats:italic>\n                    : While anticancer immunotherapies have traditionally focused on activation of the immune system, there is recent interest in disinhibition of the natural antitumor immune response by targeting immune checkpoints such as cytotoxic T\u2010lymphocyte associated antigen\u20104 (CTLA\u20104) and programmed death\u20101 (PD\u20101). One humanized monoclonal antibody against PD\u20101, pembrolizumab, was recently approved for treatment of metastatic malignant melanoma.\n                    <jats:italic>Methods<\/jats:italic>\n                    : We report exacerbation of myasthenia gravis (MG) after treatment with pembrolizumab and provide a brief literature review.\n                    <jats:italic>Results<\/jats:italic>\n                    : We describe a 75\u2010year\u2010old man with stable MG who experienced myasthenic crisis in the setting of pembrolizumab treatment. A concurrent azathioprine taper was a possible although unlikely contributor given the short time interval between taper and exacerbation.\n                    <jats:italic>Conclusions<\/jats:italic>\n                    : As long\u2010term data become available regarding the adverse immune effects of novel checkpoint inhibitors, clinicians should be mindful of their risks\/benefits and of possible autoimmune disease exacerbation.\n                    <jats:italic>Muscle Nerve<\/jats:italic>\n                    <jats:bold>54<\/jats:bold>\n                    : 157\u2013161, 2016\n                  <\/jats:p>","DOI":"10.1002\/mus.25141","type":"journal-article","created":{"date-parts":[[2016,4,11]],"date-time":"2016-04-11T12:28:06Z","timestamp":1460377686000},"page":"157-161","source":"Crossref","is-referenced-by-count":84,"title":["Exacerbation of myasthenia gravis in a patient with melanoma treated with pembrolizumab"],"prefix":"10.1002","volume":"54","author":[{"given":"K. H. Vincent","family":"Lau","sequence":"first","affiliation":[{"name":"Yale University School of Medicine, Department of Neurology, Division of Neuromuscular Medicine PO Box 208018 New Haven Connecticut 06520 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aditya","family":"Kumar","sequence":"additional","affiliation":[{"name":"Yale University School of Medicine, Department of Neurology, Division of Neuromuscular Medicine PO Box 208018 New Haven Connecticut 06520 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene Hwa","family":"Yang","sequence":"additional","affiliation":[{"name":"Yale University School of Medicine, Department of Neurology, Division of Neuromuscular Medicine PO Box 208018 New Haven Connecticut 06520 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard J.","family":"Nowak","sequence":"additional","affiliation":[{"name":"Yale University School of Medicine, Department of Neurology, Division of Neuromuscular Medicine PO Box 208018 New Haven Connecticut 06520 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,5,19]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.critrevonc.2013.08.002"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1358\/dot.2015.51.1.2250387"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1517\/14740338.2015.1021774"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.seminoncol.2015.02.015"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.coph.2015.05.011"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.immunol.26.021607.090331"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1038\/ni.2762"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1084\/jem.174.3.561"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1003466"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1074-7613(00)80089-8"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1084\/jem.20051776"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1038\/nature13954"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.4049\/jimmunol.181.10.6738"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.24899"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1093\/intimm\/10.10.1563"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0093280"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.291.5502.319"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1084\/jem.20022125"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.2353\/ajpath.2009.081012"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/1074-7613(95)90125-6"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40425-015-0078-9"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1305133"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.14694\/EdBook_AM.2015.35.76"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/CMR.0000000000000155"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40425-015-0057-1"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1097\/CJI.0000000000000060"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1097\/RLU.0000000000000940"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jns.2014.06.023"},{"key":"e_1_2_6_30_1","doi-asserted-by":"publisher","DOI":"10.1038\/nri916"},{"key":"e_1_2_6_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/0165-5728(93)90013-O"},{"key":"e_1_2_6_32_1","first-page":"71","article-title":"[Myasthenia gravis]","volume":"52","author":"Gajdos P","year":"2002","journal-title":"Rev Prat"},{"key":"e_1_2_6_33_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1331.2008.02246.x"},{"key":"e_1_2_6_34_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1749-6632.1981.tb33767.x"},{"key":"e_1_2_6_35_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.410150615"},{"key":"e_1_2_6_36_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.410170304"},{"key":"e_1_2_6_37_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1749-6632.1987.tb51327.x"},{"key":"e_1_2_6_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/0960-8966(91)90005-D"},{"key":"e_1_2_6_39_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1200694"},{"key":"e_1_2_6_40_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2013.51.1683"},{"key":"e_1_2_6_41_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.24648"},{"key":"e_1_2_6_42_1","doi-asserted-by":"publisher","DOI":"10.1158\/2326-6066.CIR-13-0146"}],"container-title":["Muscle &amp; 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