Nivolumab, a checkpoint inhibitor directed against programmed death-1 (PD-1), was
approved as the first specific immunotherapeutic agent as second-line therapy in previously
treated metastatic renal cell carcinoma (RCC) patients. A 73-year-old man with metastatic
RCC was treated with nivolumab. A few days after the second treatment with nivolumab,
he presented with diffuse muscle pain and unilateral ptosis. ECG showed Mobitz type
2 AV block and ST—segment elevation in leads II, III, aVF, V5, and V6. The laboratory
test was found to mark an increase in serum levels of creatine kinase, creatine kinase
MB-isozyme and troponin T. Echocardiographic studies revealed a severely impaired
left ventricular function. The histological analysis of a myocardial biopsy showed
lymphocytic infiltration with a predominance of CD3, 4, and 8 positive T cells and
macrophages. Nivolumab was discontinued and the patient was started on a high dose
of steroids. The findings of this case indicated that nivolumab can cause myocarditis,
rhabdomyolysis and myasthenia gravis.
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