Case report: A severe myositis mimicking bulbar palsy after administration of immune checkpoint inhibitors
ObjectivesImmune Checkpoint Inhibitors (ICI) are nowadays a cornerstone of anti-cancer treatments. However, the wide spectrum of immune-related adverse events (irAEs) represents a challenge in the oncological practice. Our objective is to document rare complications of ICI to help the community of o...
Saved in:
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2025-02-01
|
| Series: | Frontiers in Immunology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fimmu.2025.1496427/full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1823861049749667840 |
|---|---|
| author | Philippe Rochigneux Philippe Rochigneux Alexandre Bertucci Elika Loir Alexia Mattei Danielle Robert Michael Dassa Brice Chanez Mikael Ebbo Lea Gaigne Anne Sophie Chretien Giovanni Corazza Giovanni Corazza Nicolas Schleinitz |
| author_facet | Philippe Rochigneux Philippe Rochigneux Alexandre Bertucci Elika Loir Alexia Mattei Danielle Robert Michael Dassa Brice Chanez Mikael Ebbo Lea Gaigne Anne Sophie Chretien Giovanni Corazza Giovanni Corazza Nicolas Schleinitz |
| author_sort | Philippe Rochigneux |
| collection | DOAJ |
| description | ObjectivesImmune Checkpoint Inhibitors (ICI) are nowadays a cornerstone of anti-cancer treatments. However, the wide spectrum of immune-related adverse events (irAEs) represents a challenge in the oncological practice. Our objective is to document rare complications of ICI to help the community of onco-immunologists.MethodsWe reported the case of a severe myositis mimicking bulbar palsy treated in our Medical Oncology Department together with Internal Medicine Department. We present the clinical work-up (neurological exam, capillaroscopy) and the diagnostic tests (myositis specific and associated antibodies, nerve conduction study, electromyography) leading to this diagnosis. We also discussed the elimination of differential diagnoses (notably with normal MRI and cerebrospinal fluid analysis) and finally the clinical management of this severe irAE.ResultsA 57 years woman presented multiple sub-diaphragmatic adenopathies related with an advanced melanoma of unknown primary. She started a treatment with Ipilimumab (Ipi, anti CTLA-4) and Nivolumab (Nivo, anti PD-1) and presented at day 10 a grade IV myositis mimicking bulbar palsy with dysphonia, dysarthria and aphagia. In a multidisciplinary setting, she was treated with IV corticosteroids (methylprednisolone 1 mg/kg started at day 10, with a progressive decrease until 1 mg of prednisone in March 2024), IV immunoglobulins started at day 18 (1.5 g/kg in 2 days, administered monthly, with a progressive decrease and a cessation in June 2022), enteral nutrition, speech therapy and physical therapy, with noticeable improvement. After 4 years of follow-up, and only one infusion of Ipi/Nivo, the melanoma is still in complete response.ConclusionWe report an ICI-induced severe myositis mimicking bulbar palsy after the administration of Ipi/Nivo. The diagnosis and clinical care management of this rare complication requires a multi-disciplinary work-up. |
| format | Article |
| id | doaj-art-a5ff7ccb04b1483a983afd51301d211f |
| institution | Kabale University |
| issn | 1664-3224 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Immunology |
| spelling | doaj-art-a5ff7ccb04b1483a983afd51301d211f2025-02-10T06:48:31ZengFrontiers Media S.A.Frontiers in Immunology1664-32242025-02-011610.3389/fimmu.2025.14964271496427Case report: A severe myositis mimicking bulbar palsy after administration of immune checkpoint inhibitorsPhilippe Rochigneux0Philippe Rochigneux1Alexandre Bertucci2Elika Loir3Alexia Mattei4Danielle Robert5Michael Dassa6Brice Chanez7Mikael Ebbo8Lea Gaigne9Anne Sophie Chretien10Giovanni Corazza11Giovanni Corazza12Nicolas Schleinitz13Medical Oncology Department, Paoli-Calmettes Institute, Marseille, FranceTeam Immunity and Cancer, Centre de Recherche en Cancérologie de Marseille (CRCM), Inserm, U1068, Centre National de la Recherche Scientifique (CNRS), UMR7258, Paoli-Calmettes Institute, Aix-Marseille University, Marseille, FranceMedical Oncology Department, Paoli-Calmettes Institute, Marseille, FranceMedical Oncology Department, Paoli-Calmettes Institute, Marseille, FranceOtolaryngology Department, Assistance Publique Hôpitaux de Marseille, Aix-Marseille University, Marseille, FranceOtolaryngology Department, Assistance Publique Hôpitaux de Marseille, Aix-Marseille University, Marseille, FranceRadiology Department, Paoli-Calmettes Institute, Marseille, FranceMedical Oncology Department, Paoli-Calmettes Institute, Marseille, FranceInternal Medicine Department, Assistance Publique Hôpitaux de Marseille, Aix-Marseille University, Marseille, FranceInternal Medicine Department, Assistance Publique Hôpitaux de Marseille, Aix-Marseille University, Marseille, FranceTeam Immunity and Cancer, Centre de Recherche en Cancérologie de Marseille (CRCM), Inserm, U1068, Centre National de la Recherche Scientifique (CNRS), UMR7258, Paoli-Calmettes Institute, Aix-Marseille University, Marseille, FranceNeurology Department, Assistance Publique Hôpitaux de Marseille, Aix-Marseille University, Marseille, FranceReferral Centre for Neuromuscular Diseases and Amyotrophic Lateral Sclerosis (ALS), Hôpital La Timone, Marseille, FranceInternal Medicine Department, Assistance Publique Hôpitaux de Marseille, Aix-Marseille University, Marseille, FranceObjectivesImmune Checkpoint Inhibitors (ICI) are nowadays a cornerstone of anti-cancer treatments. However, the wide spectrum of immune-related adverse events (irAEs) represents a challenge in the oncological practice. Our objective is to document rare complications of ICI to help the community of onco-immunologists.MethodsWe reported the case of a severe myositis mimicking bulbar palsy treated in our Medical Oncology Department together with Internal Medicine Department. We present the clinical work-up (neurological exam, capillaroscopy) and the diagnostic tests (myositis specific and associated antibodies, nerve conduction study, electromyography) leading to this diagnosis. We also discussed the elimination of differential diagnoses (notably with normal MRI and cerebrospinal fluid analysis) and finally the clinical management of this severe irAE.ResultsA 57 years woman presented multiple sub-diaphragmatic adenopathies related with an advanced melanoma of unknown primary. She started a treatment with Ipilimumab (Ipi, anti CTLA-4) and Nivolumab (Nivo, anti PD-1) and presented at day 10 a grade IV myositis mimicking bulbar palsy with dysphonia, dysarthria and aphagia. In a multidisciplinary setting, she was treated with IV corticosteroids (methylprednisolone 1 mg/kg started at day 10, with a progressive decrease until 1 mg of prednisone in March 2024), IV immunoglobulins started at day 18 (1.5 g/kg in 2 days, administered monthly, with a progressive decrease and a cessation in June 2022), enteral nutrition, speech therapy and physical therapy, with noticeable improvement. After 4 years of follow-up, and only one infusion of Ipi/Nivo, the melanoma is still in complete response.ConclusionWe report an ICI-induced severe myositis mimicking bulbar palsy after the administration of Ipi/Nivo. The diagnosis and clinical care management of this rare complication requires a multi-disciplinary work-up.https://www.frontiersin.org/articles/10.3389/fimmu.2025.1496427/fullimmune-related myositisbulbar palsyimmune checkpoint inhibitorsimmune toxicityipilimumab/nivolumab |
| spellingShingle | Philippe Rochigneux Philippe Rochigneux Alexandre Bertucci Elika Loir Alexia Mattei Danielle Robert Michael Dassa Brice Chanez Mikael Ebbo Lea Gaigne Anne Sophie Chretien Giovanni Corazza Giovanni Corazza Nicolas Schleinitz Case report: A severe myositis mimicking bulbar palsy after administration of immune checkpoint inhibitors Frontiers in Immunology immune-related myositis bulbar palsy immune checkpoint inhibitors immune toxicity ipilimumab/nivolumab |
| title | Case report: A severe myositis mimicking bulbar palsy after administration of immune checkpoint inhibitors |
| title_full | Case report: A severe myositis mimicking bulbar palsy after administration of immune checkpoint inhibitors |
| title_fullStr | Case report: A severe myositis mimicking bulbar palsy after administration of immune checkpoint inhibitors |
| title_full_unstemmed | Case report: A severe myositis mimicking bulbar palsy after administration of immune checkpoint inhibitors |
| title_short | Case report: A severe myositis mimicking bulbar palsy after administration of immune checkpoint inhibitors |
| title_sort | case report a severe myositis mimicking bulbar palsy after administration of immune checkpoint inhibitors |
| topic | immune-related myositis bulbar palsy immune checkpoint inhibitors immune toxicity ipilimumab/nivolumab |
| url | https://www.frontiersin.org/articles/10.3389/fimmu.2025.1496427/full |
| work_keys_str_mv | AT philipperochigneux casereportaseveremyositismimickingbulbarpalsyafteradministrationofimmunecheckpointinhibitors AT philipperochigneux casereportaseveremyositismimickingbulbarpalsyafteradministrationofimmunecheckpointinhibitors AT alexandrebertucci casereportaseveremyositismimickingbulbarpalsyafteradministrationofimmunecheckpointinhibitors AT elikaloir casereportaseveremyositismimickingbulbarpalsyafteradministrationofimmunecheckpointinhibitors AT alexiamattei casereportaseveremyositismimickingbulbarpalsyafteradministrationofimmunecheckpointinhibitors AT daniellerobert casereportaseveremyositismimickingbulbarpalsyafteradministrationofimmunecheckpointinhibitors AT michaeldassa casereportaseveremyositismimickingbulbarpalsyafteradministrationofimmunecheckpointinhibitors AT bricechanez casereportaseveremyositismimickingbulbarpalsyafteradministrationofimmunecheckpointinhibitors AT mikaelebbo casereportaseveremyositismimickingbulbarpalsyafteradministrationofimmunecheckpointinhibitors AT leagaigne casereportaseveremyositismimickingbulbarpalsyafteradministrationofimmunecheckpointinhibitors AT annesophiechretien casereportaseveremyositismimickingbulbarpalsyafteradministrationofimmunecheckpointinhibitors AT giovannicorazza casereportaseveremyositismimickingbulbarpalsyafteradministrationofimmunecheckpointinhibitors AT giovannicorazza casereportaseveremyositismimickingbulbarpalsyafteradministrationofimmunecheckpointinhibitors AT nicolasschleinitz casereportaseveremyositismimickingbulbarpalsyafteradministrationofimmunecheckpointinhibitors |