{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T15:26:00Z","timestamp":1791559560904,"version":"4.3.4"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"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:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Immune checkpoint inhibitors (ICIs) can cause rare but clinically important immune-related neuromuscular adverse events. Early warning signals for ICI-associated neuromuscular toxicity remain poorly defined, particularly after PD-1 inhibitor rechallenge.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>We report a 71-year-old woman with metastatic hepatocellular carcinoma who developed progressive bilateral ptosis and blurred vision approximately 20 days after camrelizumab rechallenge following a prolonged treatment-free interval. Repetitive nerve stimulation of the left orbicularis oculi muscle showed a 24.8% decremental response, suggesting possible ocular neuromuscular junction involvement. Serial laboratory data showed progressive increases in muscle injury-related biomarkers, including CK, CK-MB, MYO, LDH, and \u03b1-HBDH, before hospitalization and before overt neurological deterioration. Cranial MRI and MRA excluded structural central nervous system lesions. Flow cytometric immune profiling showed descriptive changes in CD4+ T-cell parameters and granzyme B-positive CD8+ T-cell proportions, but these findings were not interpreted as evidence of causal immune activation. cTnI was measured using an immunoturbidimetric assay and did not exceed the laboratory-reported reference range; therefore, myocardial injury or ICI-associated myocarditis could not be established with the available data. Based on the temporal association with camrelizumab rechallenge, ocular manifestations, a suggestive RNS finding, serial muscle injury-related biomarker abnormalities, exclusion of structural central nervous system lesions, and clinical improvement after glucocorticoid therapy, camrelizumab-associated immune-related neuromuscular toxicity or an MG-like ocular syndrome was considered.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This case highlights camrelizumab-associated MG-like ocular neuromuscular toxicity after PD-1 inhibitor rechallenge. Its main noteworthy feature is the availability of serial pre-hospitalization biomarker data showing progressive muscle injury-related biomarker abnormalities before overt neurological deterioration. Definite immune-related MG and ICI-associated myocarditis could not be established because confirmatory serological, electrophysiological, and cardiac investigations were incomplete. Longitudinal assessment of muscle injury-related biomarkers may help identify evolving immune-related neuromuscular toxicity in selected patients, although larger studies are needed for validation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1908789","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T04:47:37Z","timestamp":1785905257000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Camrelizumab-associated MG-like ocular neuromuscular toxicity after PD-1 inhibitor rechallenge in metastatic hepatocellular carcinoma: a case report with serial muscle injury-related biomarker changes"],"prefix":"10.3389","volume":"17","author":[{"given":"Jie","family":"Li","sequence":"first","affiliation":[{"name":"Gastroenterology Department, Wanbei Coal Electric Group General Hospital","place":["Suzhou, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengdie","family":"Chen","sequence":"additional","affiliation":[{"name":"Respiratory Department, Wanbei Coal Electric Group General Hospital","place":["Suzhou, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lusheng","family":"Wang","sequence":"additional","affiliation":[{"name":"Central Laboratory, Wanbei Coal Electric Group General Hospital","place":["Suzhou, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kesheng","family":"Bo","sequence":"additional","affiliation":[{"name":"Respiratory Department, Wanbei Coal Electric Group General Hospital","place":["Suzhou, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming","family":"Chen","sequence":"additional","affiliation":[{"name":"Respiratory Department, Wanbei Coal Electric Group General Hospital","place":["Suzhou, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Jiang","sequence":"additional","affiliation":[{"name":"Respiratory Department, Wanbei Coal Electric Group General Hospital","place":["Suzhou, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,5]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1016\/j.esmogo.2023.08.004","article-title":"Immune checkpoint inhibition (ICI) in current systemic therapies for hepatocellular carcinoma (HCC)","volume":"1","author":"van B\u00f6mmel","year":"2023","journal-title":"Esmo Gastrointest Oncol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1159\/000549355","article-title":"Rechallenge with immune checkpoint inhibitors in patients with hepatocellular carcinoma: A narrative review","author":"Li","year":"2025","journal-title":"Liver Cancer"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1159\/000551629","article-title":"Immune checkpoint inhibitor rechallenge in unresectable hepatocellular carcinoma: A multicenter efficacy and safety study","author":"Chen","year":"2026","journal-title":"Liver Cancer"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.2174\/22123970mte09mdyg0","article-title":"Current status and prospects of camrelizumab, a humanized antibody against programmed cell death receptor 1","volume":"16","author":"Song","year":"2021","journal-title":"Recent Pat Anticancer Drug Discov"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2025.1680838","article-title":"Combination of PD-1\/PD-L1 and CTLA-4 inhibitors in the treatment of\u00a0cancer - 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