Abstract

Nivolumab, an immune check point inhibitor (ICI), inhibits programmed cell death protein 1 (PD-1) and increases the immunity to fight against the cancer cells. Myasthenia gravis (MG) is a rare and lifethreatening adverse effect triggered by nivolumab. We described a 65-year-old patient with the hepatocellular carcinoma who developed MG and myositis after one cycle of nivolumab. The myasthenic symptoms deteriorated to impending myasthenic crisis in few days despite high dose steroids. We performed plasmapheresis and reversed the progressions to respiratory failure. Early recognition and comprehensive investigation of MG is important in these patients with ICI therapy. Concurrent treatments of plasmapheresis and steroids for ICI-related MG may be an effective management.