TY - JOUR
AR - ACO-2019-2-101
TI - Management of myasthenia gravis without significant exacerbation during nivolumab therapy for metastatic melanoma: a case report and review of literature
AU - Collichio , Frances
AU - James F Jr, Howard 
AU - Yash , Agrawal
JO - Annals of Clinical Oncology
PY - 2019
DA - Wed 22, May 2019
SN - 2674-3248
DO - http://dx.doi.org/10.31487/j.ACO.2019.02.01
UR - https://www.sciencerepository.org/management-of-myasthenia-gravis-without-significant-exacerbation-during-nivolumab-therapy-for-metastatic-melanoma_ACO-2019-2-101 
KW - Myasthenia gravis, melanoma, neurology, neuromuscular disease, skin cancer, immunology, safety, immunotherapy, autoimmune disease, anti-PD-1
AB - A 51-year-old man with myasthenia gravis (MG) and metastatic melanoma had progression of his melanoma
with supratentorial metastases on dabrafenib-trametinib and was transitioned to anti-PD1 immunotherapy
with nivolumab. He presented to the hospital soon after starting nivolumab with headache, mild diplopia,
and right-sided dysdiadochokinesia and reduced proprioception. EMG showed a mildly increased
percentage of fiber pairs with increased jitter without impulse blocking, and MG outcome measures were
worse, consistent with mild exacerbation. He continued to receive pyridostigmine, and after discharge
showed functional improvement and return of his MG outcome measures to baseline. Nivolumab was
continued for three months without further MG exacerbations until disease progression in the liver,
mesentery, and lung. Close monitoring of neurological autoimmune conditions by neurology in conjunction
with oncology could help ensure greater patient safety during anti-PD1 immunotherapy treatment in MG
patients. We recommend pursuit of larger trials to clarify immunotherapy safety profiles in such patients.