An overlap syndrome of myasthenia gravis, myocarditis, myositis and hepatitis triggered by immune checkpoint inhibitor use

Abstract Immune checkpoint inhibitors (ICIs), while revolutionizing cancer treatment, can lead to a spectrum of side effects due to their broad impact on the immune system. Common side effects include fatigue, skin reactions and gastrointestinal issues. However, ICIs can also induce immune-related adverse events (irAEs), affecting various organs, such as the lungs, liver and endocrine system. Severe irAEs, though infrequent, can include myocarditis, colitis and neurologic complications such as neuropathy and myasthenia gravis. Vigilant monitoring and collaborative management by healthcare providers are essential to balance the anti-tumour effects of ICIs with the potential autoimmune consequences. We describe a case of ICI-induced myasthenia gravis, myocarditis, myositis and hepatitis that was recognized and managed in the broader context of myasthenia gravis. It is essential that patients on ICIs to be regularly monitored for irAEs during treatment for their malignancies due to the risk of potentially fatal complications.