{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T16:22:07Z","timestamp":1784132527595,"version":"3.55.0"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T00:00:00Z","timestamp":1764288000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>Immune checkpoint inhibitor (ICI)-associated myocarditis is a rare yet life-threatening immune-related adverse event (irAE), whose management is even more challenging when complicated by an impending crisis of myasthenia gravis (MG). This article presents a case of a 69-year-old woman with bladder malignancy, coexisting MG, diabetes, hypertension, and coronary artery disease. On day 16 after tislelizumab (PD-1 inhibitor) therapy, she exhibited aggravated MG symptoms, with an impending crisis, alongside asymptomatic ICI-associated myocarditis. Clinical manifestations included generalized fatigue, anorexia, bilateral ptosis, dysarthria, neck and limb weakness, shortness of breath, and dyspnea. Laboratory tests revealed elevated troponin T, troponin I, creatine kinase (CK), creatine kinase\u2013myocardial band (CK-MB), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) levels, suggesting a diagnosis of ICI-associated myocarditis and liver injury. Doppler ultrasound indicated thrombosis in the left calf muscle space. Treatment with efgartigimod (10 mg\/kg) significantly improved myasthenic symptoms, with Myasthenia Gravis\u2013Activities of Daily Living (MG-ADL) and Quantitative Myasthenia Gravis (QMG) scores decreasing from 11 to 5 and 26 to 11, respectively. Treatment with prednisone acetate (60 mg once daily) resulted in gradual reductions in myocardial enzymes, troponins, and transaminases. Efgartigimod demonstrated notable efficacy as salvage therapy for ICI-associated myocarditis, myositis, liver injury, and impending crisis of MG. Early recognition and tailored treatment strategies are crucial for improving patient outcomes in such complex cases.<\/jats:p>","DOI":"10.3389\/fimmu.2025.1671964","type":"journal-article","created":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T06:29:54Z","timestamp":1764311394000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Efgartigimod for the treatment of immune checkpoint inhibitor-associated myocarditis complicated with impending crisis state of myasthenia gravis: a case report"],"prefix":"10.3389","volume":"16","author":[{"given":"Mingjia","family":"Lu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayikemaier","family":"Muhetaer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chenxi","family":"Su","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meng","family":"Dong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kariman","family":"Aili","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Sha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaidierya","family":"Aimudula","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kailibinuer","family":"Abudureheman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maynur","family":"Mamat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongyan","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,11,28]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.2482\/haigan.59.217","article-title":"Current status and future direction of immune checkpoint inhibitors","volume":"59","author":"Kagamu","year":"2019","journal-title":"Haigan"},{"key":"B2","doi-asserted-by":"crossref","DOI":"10.54097\/hset.v36i.6122","article-title":"Checkpoint inhibitors: limitations and potential strategies","volume-title":"Highlights in science","author":"Fan","year":"2023"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-pathol-042020-042741","article-title":"Immune checkpoint inhibitors for the treatment of cancer: clinical impact and mechanisms of response and resistance","volume":"16","author":"Bagchi","year":"2020","journal-title":"Annu Rev Pathol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.3390\/cancers14143495","article-title":"HSPG2 mutation association with immune checkpoint inhibitor outcome in melanoma and non-small cell lung cancer","volume":"14","author":"Zhang","year":"2022","journal-title":"Cancers"},{"key":"B5","doi-asserted-by":"publisher","first-page":"Abstract nr 5702","DOI":"10.1158\/1538-7445.AM2018-5702","article-title":"Abstract 5702: Characterization of circulating tumor cells during immune checkpoint inhibition in metastatic renal cell carcinoma and Malignant melanoma","volume":"78","author":"Zhang","year":"2018","journal-title":"Clin Res (Excluding Clin Trials)"},{"key":"B6","doi-asserted-by":"crossref","first-page":"390","DOI":"10.21037\/jgo.2018.01.03","article-title":"Immune checkpoint inhibitors in gastrointestinal Malignancies","author":"Jindal","year":"2018","journal-title":"J gastrointestinal Oncol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"5487","DOI":"10.3390\/cancers15225487","article-title":"Cardiotoxicity associated with immune checkpoint inhibitors","volume":"15","author":"Minegishi","year":"2023","journal-title":"Cancers"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1007\/s40259-016-0204-3","article-title":"Immune-related adverse events associated with immune checkpoint inhibitors","volume":"30","author":"Day","year":"2016","journal-title":"BioDrugs"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.14310\/horm.2002.1754","article-title":"Endocrine sequelae of immune checkpoint inhibitors","volume":"16","author":"Ntali","year":"2017","journal-title":"Hormones"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.3390\/cancers15051433","article-title":"Immune checkpoint inhibitors for solid tumors in the adjuvant setting: current progress, future directions, and role in transplant oncology","volume":"15","author":"Abboud","year":"2023","journal-title":"Cancers"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1016\/j.gendis.2023.01.024","article-title":"Immune checkpoint inhibitors break whose heart? 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