Myasthenia gravis associated with nivolumab therapy in a patient with melanoma

Megan Landon, Timothy Panella


Introduction: Immune checkpoint inhibitors exhibit robust antitumor activity in melanoma treatment but can induce highly toxic immunogenic effects. This case details an uncommonly severe adverse reaction to immune therapy and demonstrates the importance of identifying toxicities early to avoid adverse treatment outcomes.

Presentation of Case: We present a patient who received anti-PD1 immunotherapy, nivolumab, as a second-line treatment for stage IV resected melanoma. The patient experienced several immune-related adverse effects and was diagnosed with myasthenia gravis. Despite receiving steroid, immunoglobin, and plasmapheresis treatment, the patient passed away.

Conclusion: This case highlights the importance of closely monitoring and quickly addressing symptoms of nivolumab toxicity. Rapid institution of immunosuppressive therapy is not always successful.


Melanoma; immunotherapy toxicity; adverse effects of immunotherapy

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