{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T23:16:29Z","timestamp":1777936589407,"version":"3.51.4"},"reference-count":6,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2020,1,1]],"date-time":"2020-01-01T00:00:00Z","timestamp":1577836800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Clin Med Insights Oncol"],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:p>Immunotherapy agents such as ipilimumab and nivolumab are immensely effective in the treatment of various malignancies. Despite this, neurologic immune-related sequelae (NIRS) have been observed. Prompt diagnosis and treatment is critical to improve patient outcomes. We present a case of a 63-year-old man with stage IV metastatic melanoma beginning treatment with ipilimumab and nivolumab. Gathered history from the patient showed that he had a 3-year presentation of bradykinesia, shuffling gait, and muscle cramping. After one dose, the patient began to have progressively worsening generalized weakness; after receiving the immunotherapy, there was a rapid decline in his health. In addition to weakness, the patient developed diplopia, impaired single breath count, lingual and upper\/lower extremity fasciculations, and brisk reflexes. While the lumbar puncture and myasthenia panel were non-diagnostic, the electromyography (EMG) revealed axonal neuropathy and diffuse denervation\/reinnervation changes. Furthermore, a magnetic resonance imaging (MRI) displayed fatty replacement of the tongue with a bright tongue sign. These results pointed to the diagnosis of amyotrophic lateral sclerosis (ALS) superimposed onto myasthenic-like syndrome. The patient was started on various treatments; however, unfortunately he died due to acute hypoxic respiratory failure. This case highlights important considerations that must be taken when using immunotherapy, especially in patients with pre-existing neurological deficits. Furthermore, it shows the importance of early diagnosis as treatment can potentially cure adverse sequelae.<\/jats:p>","DOI":"10.1177\/1179554920978024","type":"journal-article","created":{"date-parts":[[2020,12,28]],"date-time":"2020-12-28T05:17:47Z","timestamp":1609132667000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["Immunotherapy Induced Myasthenic-Like Syndrome in a Metastatic Melanoma Patient With Amyotrophic Lateral Sclerosis"],"prefix":"10.1177","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4218-2346","authenticated-orcid":false,"given":"Muhammad","family":"Jaffer","sequence":"first","affiliation":[{"name":"University of South Florida, Tampa, FL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew","family":"Chung","sequence":"additional","affiliation":[{"name":"University of South Florida, Tampa, FL, USA"},{"name":"MD Anderson Cancer Center, Houston, TX, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Esha","family":"Sharda","sequence":"additional","affiliation":[{"name":"University of South Florida, Tampa, FL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asha","family":"Ramsakal","sequence":"additional","affiliation":[{"name":"University of South Florida, Tampa, FL, USA"},{"name":"Moffitt Cancer Center, Tampa, FL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edwin","family":"Peguero","sequence":"additional","affiliation":[{"name":"University of South Florida, Tampa, FL, USA"},{"name":"Moffitt Cancer Center, Tampa, FL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neha","family":"Verma","sequence":"additional","affiliation":[{"name":"University of South Florida, Tampa, FL, USA"},{"name":"Moffitt Cancer Center, Tampa, FL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sepideh","family":"Mokhtari","sequence":"additional","affiliation":[{"name":"University of South Florida, Tampa, FL, USA"},{"name":"Moffitt Cancer Center, Tampa, FL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2020,12,28]]},"reference":[{"key":"bibr1-1179554920978024","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2017.77.6385"},{"key":"bibr2-1179554920978024","doi-asserted-by":"publisher","DOI":"10.1177\/1352458514549403"},{"key":"bibr3-1179554920978024","doi-asserted-by":"publisher","DOI":"10.3233\/JND-170219"},{"key":"bibr4-1179554920978024","doi-asserted-by":"publisher","DOI":"10.1177\/1756286418799864"},{"key":"bibr5-1179554920978024","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2016.34.15_suppl.9515"},{"key":"bibr6-1179554920978024","doi-asserted-by":"publisher","DOI":"10.1002\/mus.26289"}],"container-title":["Clinical Medicine Insights: Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1179554920978024","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/1179554920978024","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1179554920978024","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T03:37:24Z","timestamp":1777693044000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/1179554920978024"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,1]]},"references-count":6,"alternative-id":["10.1177\/1179554920978024"],"URL":"https:\/\/doi.org\/10.1177\/1179554920978024","relation":{},"ISSN":["1179-5549","1179-5549"],"issn-type":[{"value":"1179-5549","type":"print"},{"value":"1179-5549","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,1]]},"article-number":"1179554920978024"}}