[Myasthenia gravis induced by inmuno checkpoints inhibitors: first case report secondary to avelumab therapy and review of published cases].

INTRODUCTION

The inmuno checkpoints inhibitors are new revolutionary treatment for many neoplastic diseases in advanced stadium. There are described several types of neurological complications induced by nivolumab: polyneuropathy, seizures, radiculitis and myasthenia gravis disease.

CASE REPORT: A 65 years old man with metastatic lung adenocarcinoma who presented myasthenia gravis disease induced by avelumab therapy with good response to treatment with pyridostigmine and withdrawal of avelumab.

CONCLUSIONS

The exact mechanism by which this drug induces myasthenia gravis is still unknown and there is probably a different pathophysiological process to idiopathic myasthenia gravis. An important fact is the variability in the time of onset of myasthenia gravis after initiating treatment with inmuno checkpoints inhibitors. From the clinical point of view, most of the reported cases appeared with a generalized form of myasthenia gravis with bulbar involvement and later developed ophthalmoparesis and fluctuating palpebral ptosis. Our case as well as the review of the previous literature can be useful to alert the clinical neurologist about the possibility of the development of immune-mediated cases of this nature induced by the treatment with avelumab in clinical practice as well as to guide its clinical, prognostic and clinical characteristics.