Avelumab-Induced Ocular Myasthenia Gravis: A Case Report

Avelumab, a programmed death-ligand 1 (PD-L1) inhibitor, has shown efficacy in renal cell carcinoma (RCC) but is associated with immune-related adverse events (irAEs), including rare neurological complications such as myasthenia gravis (MG). We report a case of a 75-year-old male patient with metastatic RCC receiving avelumab and axitinib who developed bilateral ptosis and ophthalmoplegia. Notably, there were no swallowing difficulties, limb weakness, or sensory deficits. The patient was treated with pyridostigmine and a weaning course of steroids per neurology input. Avelumab was eventually stopped due to the recurrence of symptoms. This case highlights the importance of early recognition and management of immune checkpoint inhibitor-induced MG to balance oncologic benefits with potential toxicities while also underlining the value of a multidisciplinary team (MDT) approach.