{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:36:05Z","timestamp":1787016965491,"version":"build-2736575974"},"reference-count":16,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2022,11,25]]},"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:p>\n                    Pembrolizumab, a humanised monoclonal antibody and immune checkpoint inhibitor (ICI) that blocks programmed death receptor 1 and its ligands, is an effective immunotherapy for malignancies such as\n                    <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/en.wikipedia.org\/wiki\/Melanoma\">melanoma<\/jats:ext-link>\n                    , lung, head and neck, cancers, and Hodgkin\u2019s lymphoma. It has an overall response rate between 73% and 83%, with complete response rate of 27%\u201330%. It is well tolerated with minor side effects in 70% of cases characterised by fatigue, rash, pruritus and diarrhoea. In rare cases, more serious and life-threatening complications can occur at a rate of 0.3%\u20131.3%. We report a case of a woman in her 70s with non-small-cell lung cancer treated with ICI. She presented to the emergency department with left-sided ptosis and muscle weakness 3\u2009weeks of her first dose of pembrolizumab infusion as a treatment plan of her cancer. She was diagnosed with myasthenia gravis, myocarditis and myositis as ICI-induced immune-related adverse effects resistant to medical intervention. We wish to raise awareness of the triad of life-threatening complication of ICI therapy that accounts for 30%\u201350% of fatal complications.\n                  <\/jats:p>","DOI":"10.1136\/bcr-2022-251966","type":"journal-article","created":{"date-parts":[[2022,12,8]],"date-time":"2022-12-08T09:40:18Z","timestamp":1670492418000},"page":"e251966","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":16,"title":["Myasthenia gravis, myositis and myocarditis: a fatal triad of immune-related adverse effect of immune checkpoint inhibitor treatment"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8084-7193","authenticated-orcid":false,"given":"Biji","family":"Soman","sequence":"first","affiliation":[{"name":"Department of Cardiology, Milton Keynes University Hospital, Milton Keynes, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Cecilia","family":"Dias","sequence":"additional","affiliation":[{"name":"Department of Oncology, Milton Keynes University Hospital, Milton Keynes, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syed Azhar J","family":"Rizvi","sequence":"additional","affiliation":[{"name":"Department of Oncology, Milton Keynes University Hospital, Milton Keynes, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0231-7605","authenticated-orcid":false,"given":"Attila","family":"Kardos","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Milton Keynes University Hospital, Milton Keynes, UK"},{"name":"Faculty of Medicine and Health Sciences, The University of Buckingham, Buckingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,12,8]]},"reference":[{"key":"2025082709490516000_15.12.e251966.1","doi-asserted-by":"crossref","first-page":"4297","DOI":"10.2147\/CMAR.S151023","article-title":"Clinical utility of pembrolizumab in the management of advanced solid tumors: an evidence-based review on the emerging new data","volume":"11","author":"du Rusquec","year":"2019","journal-title":"Cancer Manag Res"},{"key":"2025082709490516000_15.12.e251966.2","doi-asserted-by":"crossref","first-page":"2777","DOI":"10.1080\/21645515.2016.1199310","article-title":"Pembrolizumab (Keytruda)","volume":"12","author":"Kwok","year":"2016","journal-title":"Hum Vaccin Immunother"},{"key":"2025082709490516000_15.12.e251966.3","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1111\/1759-7714.13315","article-title":"Management of immune checkpoint inhibitor-related adverse events: a review of case reports","volume":"11","author":"Si","year":"2020","journal-title":"Thorac Cancer"},{"key":"2025082709490516000_15.12.e251966.4","doi-asserted-by":"crossref","first-page":"1721","DOI":"10.1001\/jamaoncol.2018.3923","article-title":"Fatal toxic effects associated with immune checkpoint inhibitors: a systematic review and meta-analysis","volume":"4","author":"Wang","year":"2018","journal-title":"JAMA Oncol"},{"key":"2025082709490516000_15.12.e251966.5","doi-asserted-by":"crossref","unstructured":"Johnson DB , Manouchehri A , Haugh AM , et al . Neurologic toxicity associated with immune checkpoint inhibitors: a pharmacovigilance study. 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Immune checkpoint inhibitor-induced myasthenia gravis. Front Neurol 2020;11.doi:10.3389\/fneur.2020.00634","DOI":"10.3389\/fneur.2020.00634"},{"key":"2025082709490516000_15.12.e251966.12","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2018-0157"},{"key":"2025082709490516000_15.12.e251966.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.02.037"},{"key":"2025082709490516000_15.12.e251966.14","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2018-0130"},{"key":"2025082709490516000_15.12.e251966.15","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.ajem.2021.03.005","article-title":"Immune checkpoint inhibitor-associated myasthenia gravis, myositis, and myocarditis overlap syndrome","volume":"46","author":"Lipe","year":"2021","journal-title":"Am J Emerg Med"},{"key":"2025082709490516000_15.12.e251966.16","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.21.01440"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2022-251966","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T16:49:15Z","timestamp":1756313355000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2022-251966"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12]]},"references-count":16,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2022,12,8]]},"published-print":{"date-parts":[[2022,12]]}},"alternative-id":["10.1136\/bcr-2022-251966"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2022-251966","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12]]}}}