{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T13:35:45Z","timestamp":1787319345569,"version":"build-2736575974"},"reference-count":10,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,5,12]]},"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:p>This case report concerns a 63-year-old man affected by metastatic undifferentiated liposarcoma. After receiving pembrolizumab as a second-line treatment in a clinical trial, the patient experienced an immune-mediated myocarditis, myositis and myasteniform syndrome. The last two adverse events showed significant clinical relevance in terms of severity, duration and the required specific treatment.<\/jats:p>\n                  <jats:p>Initial treatment approach consisted in pulses of 1 g of methylprednisolone, followed by 2 mg\/kg\/day, with clinical improvement. After 12 days, the immune-mediated myasteniform syndrome worsened, with dysphagia, dysphonia, bilateral palpebral ptosis and respiratory difficulty. Due to the refractoriness to glucocorticoid treatment, it was decided to initiate intravenous immunoglobulin at 2 g\/kg, followed by 2 mg\/kg every 4 weeks once discharged and mycophenolate 500 mg\/12 hours, in order to reduce the dose of glucocorticoids.<\/jats:p>\n                  <jats:p>After 2 months, the patient presented an optimal clinical evolution, without muscular weakness and referred to an improvement in dysphagia and speech.<\/jats:p>","DOI":"10.1136\/bcr-2021-241766","type":"journal-article","created":{"date-parts":[[2021,7,21]],"date-time":"2021-07-21T12:57:38Z","timestamp":1626872258000},"page":"e241766","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Myositis and myasteniform syndrome related to pembrolizumab"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8861-4768","authenticated-orcid":false,"given":"Pablo","family":"Sanchez-Sancho","sequence":"first","affiliation":[{"name":"Pharmacy Department, Hospital Vall d'Hebron, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert","family":"Selva-O'Callaghan","sequence":"additional","affiliation":[{"name":"Systemic Autoimmune Diseases Unit, Hospital Vall d'Hebron, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ernesto","family":"Trallero-Aragu\u00e1s","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, Hospital Vall d'Hebron, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"Ros","sequence":"additional","affiliation":[{"name":"Medical Oncology, Hospital Vall d'Hebron, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"Montoro","sequence":"additional","affiliation":[{"name":"Pharmacy Department, Hospital Vall d'Hebron, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,7,21]]},"reference":[{"key":"2025082712510636000_14.7.e241766.1","doi-asserted-by":"publisher","DOI":"10.1038\/nri2326"},{"key":"2025082712510636000_14.7.e241766.2","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1097\/WCO.0000000000000391","article-title":"Neurologic complications of immune checkpoint inhibitors","volume":"29","author":"Hottinger","year":"2016","journal-title":"Curr Opin Neurol"},{"key":"2025082712510636000_14.7.e241766.3","doi-asserted-by":"publisher","DOI":"10.1038\/nrc3239"},{"key":"2025082712510636000_14.7.e241766.4","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/j.ejca.2017.05.041","article-title":"Myasthenia gravis: an 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Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2021-241766","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T19:51:11Z","timestamp":1756324271000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2021-241766"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7]]},"references-count":10,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2021,7,21]]},"published-print":{"date-parts":[[2021,7]]}},"alternative-id":["10.1136\/bcr-2021-241766"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2021-241766","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7]]}}}