{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T00:05:52Z","timestamp":1756425952600,"version":"3.44.0"},"reference-count":6,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T00:00:00Z","timestamp":1755561600000},"content-version":"vor","delay-in-days":18,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Respirology Case Reports"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:p>Detailed clinical data on the combination immune checkpoint inhibitor (ICI) therapy in patients with myasthenia gravis (MG) remain limited. We report a case of malignant pleural mesothelioma with previously undiagnosed ocular MG. Owing to hepatic dysfunction, reduced doses of nivolumab and ipilimumab were administered before confirmation of anti\u2010acetylcholine receptor (AChR) antibody positivity. MG was diagnosed based on subtle ocular symptoms and serological tests. Prophylactic intravenous immunoglobulin and an acetylcholinesterase inhibitor were administered; combination therapy was discontinued owing to the risk of MG flare, but a partial tumour response was achieved. With disease progression, nivolumab monotherapy was reintroduced, and early steroid pulse therapy was administered owing to elevated creatine kinase, again inducing a partial response. Serological screening for anti\u2010AChR antibodies may help prevent severe MG flares and immune\u2010related adverse events. With caution, dose\u2010reduced and limited\u2010exposure ICI combination therapy may be feasible in selected patients with MG under appropriate prophylactic management.<\/jats:p>","DOI":"10.1002\/rcr2.70297","type":"journal-article","created":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T02:58:32Z","timestamp":1755658712000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Partial Response to Nivolumab and Ipilimumab in a Patient With Malignant Pleural Mesothelioma and Pre\u2010Existing Myasthenia Gravis Without Severe Flares or\u00a0Immune\u2010Related Adverse Events: A Case Report"],"prefix":"10.1002","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0646-022X","authenticated-orcid":false,"given":"Mariko","family":"Higa","sequence":"first","affiliation":[{"name":"Division of Pulmonary Medicine NHO Okinawa Hospital  Ginowan Okinawa Japan"},{"name":"Division of Pulmonary Medicine Okinawa Prefectural Chubu Hospital  Uruma Okinawa Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomoya","family":"Kuda","sequence":"additional","affiliation":[{"name":"Division of Pulmonary Medicine NHO Okinawa Hospital  Ginowan Okinawa Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuichiro","family":"Ohya","sequence":"additional","affiliation":[{"name":"Division of Neurology NHO Okinawa Hospital  Ginowan Okinawa Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6725-9127","authenticated-orcid":false,"given":"Hidenori","family":"Kawasaki","sequence":"additional","affiliation":[{"name":"Department of Surgery NHO Okinawa Hospital  Ginowan Okinawa Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,8,19]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annonc.2022.01.074"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000011124"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11910\u2010023\u201001306\u2010x"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1080\/2162402X.2023.2261264"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2024.1372861"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1080\/2162402X.2020.1748982"}],"container-title":["Respirology Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/rcr2.70297","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T16:51:50Z","timestamp":1756399910000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/rcr2.70297"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8]]},"references-count":6,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2025,8]]}},"alternative-id":["10.1002\/rcr2.70297"],"URL":"https:\/\/doi.org\/10.1002\/rcr2.70297","archive":["Portico"],"relation":{},"ISSN":["2051-3380","2051-3380"],"issn-type":[{"type":"print","value":"2051-3380"},{"type":"electronic","value":"2051-3380"}],"subject":[],"published":{"date-parts":[[2025,8]]},"assertion":[{"value":"2025-06-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-16","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-19","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70297"}}