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Case report
Immune checkpoint inhibitor-mediated myasthenia gravis with focal subclinical myocarditis progressing to symptomatic cardiac disease
  1. Phillip John Leaver1,2,
  2. Helena Sung-In Jang1,
  3. Stephen Thomas Vernon2,3,4 and
  4. Suran Loshana Fernando1,4
  1. 1Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, New South Wales, Australia
  2. 2Department of Cardiology, Royal North Shore Hospital, Sydney, New South Wales, Australia
  3. 3Cardiothoracic and Vascular Health, Kolling Institute of Medical Research, Northern Sydney Local Health District, New South Wales, Australia
  4. 4Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Dr Phillip John Leaver; phillipleaver{at}


The advent of immune checkpoint inhibitors (ICIs) for cancer therapy has heralded increasing frequency of immune-related adverse events including endocrinopathies, hepatitis, colitis and rarely myocarditis and myasthenia gravis (MG). The heterogeneity in clinical presentations regardless of organ-specific involvement can lead to delayed recognition and management of these events and adverse health outcomes. We describe a case of ICI-induced subclinical focal myocarditis that was recognised and treated in the broader context of MG. It is essential that patients with ICI-induced MG should be screened and monitored for myocarditis, a potentially fatal complication.

  • heart failure
  • radiology (diagnostics)
  • malignant disease and immunosuppression
  • skin cancer
  • unwanted effects / adverse reactions

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  • Contributors PJL, SLF, HS-IJ and STV had a joint role in conducting a literature review, drafting and editing of the manuscript. PJL was directly involved in the patients acute care and STV continues to have a role in the patients follow up.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.