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Here, through comparative genomic analysis, we identified a pathogenic p.S467C germline variant in <jats:italic>SLC22A5<\/jats:italic> in a thymoma case with ICI-induced MG, which was found to be associated with fatty acid oxidation through its regulation on L-carnitine levels. Remarkably, ICI rechallenge with L-carnitine pretreatment led to durable response without MG-related symptoms. 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