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Myasthenia gravis induced or exacerbated by immune checkpoint inhibitors: a rising concern
  1. Behnam Hajihossainlou1,
  2. Alisa Vasileva2,
  3. Sukesh Manthri3 and
  4. Kanishka Chakraborty4
  1. 1Aurora Medical Center Bay Area, Marinette, Wisconsin, USA
  2. 2Ballad Health, Johnson City, Tennessee, USA
  3. 3Mary Bird Perkins TGMC Cancer Center, Houma, Louisiana, USA
  4. 4Department of Internal Medicine, East Tennessee State University, Johnson City, Tennessee, USA
  1. Correspondence to Dr Sukesh Manthri; sukeshmanthri123{at}


Immune checkpoint inhibitors can cause immune side effects, with myasthenia gravis (MG) being relatively rare. With this review, we present 66-year-old man with melanoma treated with pembrolizumab who developed MG. With immuno-oncology (IO) single agent usage, 42 cases reported new-onset MG and 9 cases reported exacerbation of pre-existing MG. Among the patients who had new-onset MG after administration of programmed cell death protein 1 (PD-1) inhibitors, 14 patients (38.8%) developed severe respiratory failure and required intubation and 10 patients (27.02%) died. Among the patients with exacerbation of pre-existing MG after receiving PD-1 inhibitors, 1 patient (11.1%) required intubation, and no death was reported. Combination IO therapy-induced MG was reported in seven cases, with at least two cases complicated by respiratory failure and one death. Our observations suggest a possible difference in the severity of the disease and outcome among different IO therapy options.

  • oncology
  • neuromuscular disease

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  • Contributors BH and AV worked on the review of literature and prepared initial draft. SM has edited the entire manuscript to meet BMJ requirements, and worked on submission. KC supervised the entire process, edited and approved the final draft.

  • 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.

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