Use of rituximab for fulminant and refractory cases of immune checkpoint inhibitor induced myocyte injury clinically presenting with features of myasthenia gravis: a case series

Our case series highlights how patients with primary myositis or overlap myositis with myocarditis may present with bulbar symptoms that can mimic those of myasthenia gravis. Their clinical course was refractory to initial treatments but improved significantly with rituximab. While current guidelines typically recommend biologic therapies targeting T-cell-mediated immunity, our review of literature found a biological basis for targeting antibody-mediated immunity as well. This approach proved effective, enabling both patients to achieve successful discharge after a prolonged and complex hospitalization, highlighting the importance of considering treatment directed at both T-cell and B-cell immunity.