Immune checkpoint inhibitor-related myositis with ocular manifestations and fatal outcome

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.