{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T11:10:02Z","timestamp":1756293002511,"version":"3.44.0"},"reference-count":27,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,5,21]]},"published-print":{"date-parts":[[2019,6]]},"abstract":"<jats:p>Immune checkpoint inhibitors, such as pembrolizumab, have significantly improved cancer patient outcome. Toxicities are usually moderate and manageable. However, some adverse events, if not early recognised, could be life-threatening. We report a patient with non-small cell lung cancer who received treatment with pembrolizumab and developed multiple immune-related adverse events both during and after completing treatment, including rash, pericarditis, colitis and myasthenia gravis.<\/jats:p>","DOI":"10.1136\/bcr-2018-229149","type":"journal-article","created":{"date-parts":[[2019,6,5]],"date-time":"2019-06-05T06:25:14Z","timestamp":1559715914000},"page":"e229149","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":17,"title":["Cascade of immunologic adverse events related to pembrolizumab treatment"],"prefix":"10.1136","volume":"12","author":[{"given":"Arnaud","family":"Dhenin","sequence":"first","affiliation":[{"name":"Department of Medical Oncology, Hopital de Jolimont, Haine-Saint-Paul, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vassiliki","family":"Samartzi","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Hopital de Jolimont, Haine-Saint-Paul, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Lejeune","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Hopital de Jolimont, Haine-Saint-Paul, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4807-7472","authenticated-orcid":false,"given":"Emmanuel","family":"Seront","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Hopital de Jolimont, Haine-Saint-Paul, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,6,4]]},"reference":[{"key":"2025082703545844000_12.6.e229149.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.molimm.2015.02.009"},{"key":"2025082703545844000_12.6.e229149.2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.k793"},{"key":"2025082703545844000_12.6.e229149.3","doi-asserted-by":"publisher","DOI":"10.1038\/nrclinonc.2016.58"},{"key":"2025082703545844000_12.6.e229149.4","doi-asserted-by":"crossref","first-page":"1714","DOI":"10.1200\/JCO.2017.77.6385","article-title":"Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: American Society of Clinical Oncology Clinical Practice Guideline","volume":"36","author":"Brahmer","year":"2018","journal-title":"J Clin Oncol"},{"key":"2025082703545844000_12.6.e229149.5","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1007\/s11886-017-0835-0","article-title":"Cardiovascular Toxicities Associated with Cancer Immunotherapies","volume":"19","author":"Wang","year":"2017","journal-title":"Curr Cardiol Rep"},{"key":"2025082703545844000_12.6.e229149.6","first-page":"1","article-title":"Cardiac tamponade and adrenal insufficiency due to pembrolizumab: a case report","volume":"2","author":"Oristrell","year":"2018","journal-title":"Eur Heart J Case Rep"},{"key":"2025082703545844000_12.6.e229149.7","doi-asserted-by":"crossref","DOI":"10.1080\/2162402X.2017.1344805","article-title":"Incidence of immune checkpoint inhibitor-related colitis in solid tumor patients: A systematic review and meta-analysis","volume":"6","author":"Wang","year":"2017","journal-title":"Oncoimmunology"},{"key":"2025082703545844000_12.6.e229149.8","doi-asserted-by":"publisher","DOI":"10.1136\/esmoopen-2017-000278"},{"key":"2025082703545844000_12.6.e229149.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2016.02.024"},{"key":"2025082703545844000_12.6.e229149.10","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1177\/1078155216687389","article-title":"Pembrolizumab-induced myasthenia gravis: A fatal case report","volume":"24","author":"March","year":"2018","journal-title":"J Oncol Pharm Pract"},{"key":"2025082703545844000_12.6.e229149.11","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/j.nmd.2017.01.002","article-title":"Myasthenia triggered by immune checkpoint inhibitors: New case and literature review","volume":"27","author":"Gonzalez","year":"2017","journal-title":"Neuromuscul Disord"},{"key":"2025082703545844000_12.6.e229149.12","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1097\/CMR.0000000000000310","article-title":"Two cases of clinical myasthenia gravis associated with pembrolizumab use in responding melanoma patients","volume":"27","author":"Nguyen","year":"2017","journal-title":"Melanoma Res"},{"key":"2025082703545844000_12.6.e229149.13","doi-asserted-by":"crossref","first-page":"E25","DOI":"10.1002\/mus.25496","article-title":"A case of new-onset antibody-positive myasthenia gravis in a patient treated with pembrolizumab for melanoma","volume":"55","author":"Alnahhas","year":"2017","journal-title":"Muscle Nerve"},{"key":"2025082703545844000_12.6.e229149.14","doi-asserted-by":"crossref","first-page":"115","DOI":"10.3988\/jcn.2018.14.1.115","article-title":"Emergence of Myasthenia Gravis with Myositis in a Patient Treated with Pembrolizumab for Thymic Cancer","volume":"14","author":"Huh","year":"2018","journal-title":"J Clin Neurol"},{"key":"2025082703545844000_12.6.e229149.15","doi-asserted-by":"crossref","first-page":"e00355","DOI":"10.1002\/rcr2.355","article-title":"Pembrolizumab-induced myasthenia gravis with myositis in a patient with lung cancer","volume":"6","author":"Hibino","year":"2018","journal-title":"Respirol Case Rep"},{"key":"2025082703545844000_12.6.e229149.16","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/j.ejca.2017.05.041","article-title":"Myasthenia gravis: An emerging toxicity of immune checkpoint inhibitors","volume":"82","author":"Makarious","year":"2017","journal-title":"Eur J Cancer"},{"key":"2025082703545844000_12.6.e229149.17","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1212\/WNL.0000000000004359","article-title":"Nivolumab-related myasthenia gravis with myositis and myocarditis in Japan","volume":"89","author":"Suzuki","year":"2017","journal-title":"Neurology"},{"key":"2025082703545844000_12.6.e229149.18","first-page":"9","article-title":"Ipilimumab efficacy and safety in patients with advanced melanoma: a retrospective analysis of HLA subtype from four trials","volume":"10","author":"Wolchok","year":"2010","journal-title":"Cancer Immun"},{"key":"2025082703545844000_12.6.e229149.19","doi-asserted-by":"publisher","DOI":"10.1126\/science.aad1329"},{"key":"2025082703545844000_12.6.e229149.20","doi-asserted-by":"publisher","DOI":"10.1126\/science.aac4255"},{"key":"2025082703545844000_12.6.e229149.21","doi-asserted-by":"publisher","DOI":"10.1038\/ncomms10391"},{"key":"2025082703545844000_12.6.e229149.22","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdv623"},{"issue":"15_suppl","key":"2025082703545844000_12.6.e229149.23","doi-asserted-by":"crossref","first-page":"9096","DOI":"10.1200\/jco.2014.32.15_suppl.9096","article-title":"Correlation of absolute and relative eosinophil counts with immune-related adverse events in melanoma patients treated with ipilimumab","volume":"32","author":"Schindler","year":"2014","journal-title":"J Clin Oncol"},{"key":"2025082703545844000_12.6.e229149.24","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1186\/s40425-015-0081-1","article-title":"Baseline circulating IL-17 predicts toxicity while TGF-\u03b21 and IL-10 are prognostic of relapse in ipilimumab neoadjuvant therapy of melanoma","volume":"3","author":"Tarhini","year":"2015","journal-title":"J Immunother Cancer"},{"key":"2025082703545844000_12.6.e229149.25","doi-asserted-by":"crossref","DOI":"10.1080\/2162402X.2016.1231292","article-title":"Characterization of nivolumab-associated skin reactions in patients with metastatic non-small cell lung cancer","volume":"5","author":"Hasan Ali","year":"2016","journal-title":"Oncoimmunology"},{"key":"2025082703545844000_12.6.e229149.26","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1093\/annonc\/mdw640","article-title":"Antibody-mediated thyroid dysfunction during T-cell checkpoint blockade in patients with non-small-cell lung cancer","volume":"28","author":"Osorio","year":"2017","journal-title":"Ann Oncol"},{"key":"2025082703545844000_12.6.e229149.27","doi-asserted-by":"crossref","first-page":"1798","DOI":"10.1016\/j.jtho.2017.08.022","article-title":"Early Immune-Related Adverse Events and Association with Outcome in Advanced Non-Small Cell Lung Cancer Patients Treated with Nivolumab: A\u00a0Prospective Cohort Study","volume":"12","author":"Teraoka","year":"2017","journal-title":"J Thorac Oncol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2018-229149","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T10:55:07Z","timestamp":1756292107000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2018-229149"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,6]]},"references-count":27,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2019,6,4]]},"published-print":{"date-parts":[[2019,6]]}},"alternative-id":["10.1136\/bcr-2018-229149"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2018-229149","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2019,6]]}}}