Immune checkpoint inhibitor-related myositis with ocular manifestations and fatal outcome
Nuri Tuğra Uslucan
, Merve Yavuz, Esra Aşıkdoğan, Emre Kumral
Department of Neurology, Ege University Faculty of Medicine, İzmir, Türkiye
Keywords: Immune checkpoint inhibitors, immune-related neurological adverse events, myositis, pembrolizumab.
Abstract
Immune checkpoint inhibitors are increasingly used in oncology and, while effective, may cause rare but severe immune-related adverse events, including myositis. Herein, we presented the case of an 82-year-old male with urothelial bladder cancer who developed myositis following pembrolizumab therapy. The clinical presentation included ptosis, ophthalmoplegia, dysphagia, dropped head, and respiratory involvement. Laboratory evaluation revealed markedly elevated creatine kinase and troponin levels, while electromyography demonstrated myopathic changes. Antibodies associated with myositis and myasthenia gravis were negative. Despite high-dose intravenous methylprednisolone and plasmapheresis, the patient died due to refractory hypotension and subsequent cardiac arrest during his stay in the intensive care unit. This case highlighted the potentially fulminant course of immune checkpoint inhibitor-associated myositis and underscored the importance of early recognition and aggressive management, particularly in cases with bulbar and respiratory involvement.
Cite this article as: Uslucan NT, Yavuz M, Aşıkdoğan E, Kumral E. Immune checkpoint inhibitor-related myositis with ocular manifestations and fatal outcome. Turk J Neurol 2025;31(4):463-467. doi: 10.55697/tnd.2025.497.
The data that support the findings of this study are available from the corresponding author upon reasonable request.
Followed the patient, collected the clinical data, wrote the manuscript draft, corresponded with the journal, and made the revisions: N.T.U., E.K.; Performed the EMG study and contributed to drafting the electrophysiology section: E.A.; Collected clinical data and prepared tables and figures: M.Y.; Contributed to the study conception, suggested references, and critically revised the final version of the manuscript: E.K. All authors read and approved the final manuscript.
The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.
The authors received no financial support for the research and/or authorship of this article.