Rituximab for Immune Checkpoint Inhibitor Myasthenia Gravis

The use of immune checkpoint inhibitors (iCPI) in the treatment multiple cancers has gained prominence due to their high efficacy. However, neurological immune-related adverse events (irAEs) such as myasthenia gravis (MG) have been associated with iCPI therapy. Most these irAEs are rare, and many cases, diagnoses management can be challenging. We present a case 70-year-old woman stage IIIC melanoma who developed new onset gradually progressive dyspnea, diplopia, bilateral ptosis following one cycle nivolumab ipilimumab (Nivo+Ipi). She was diagnosed MG via positive serum acetylcholine receptor (AChR) antibodies. had severe dyspnea at rest, which refractory immune-suppressive therapies including prednisone, pyridostigmine, intravenous immunoglobulin (IVIG). Subsequently, she treated rituximab 375 mg/m2 monthly every four weeks significant improvement her symptoms within 48 hours each time. As implementation immunotherapy increases medical practice, may become more apparent. When first-line not adequate, other alternative should explored. This an irAE shows that provide potential benefit treating patients immunotherapy-induced standard treatments. Prospective studies needed further evaluate efficacy irAEs.