Case with Refractory Myasthenia Gravis Caused by Pembrolizumab

Nowadays, checkpoint inhibitors play a major role in the management of different types of cancers. However, we have seen variants of immune therapy-related adverse events, which usually are variables from fatigue, to neuropathy to severe devastating complications such as respiratory failure due to myasthenia gravis (MG), as we saw in our case. Our patient was started on pembrolizumab, and they developed severe respiratory failure attributed to MG after three weeks from treatment initiation. Also, the patient presented with myositis, mild myocarditis and hepatitis, which were all related to pembrolizumab.