# Myasthenia Gravis-Like Syndrome Resulting From Immune Checkpoint Inhibitors in a Patient With Urothelial Carcinoma

## TL;DR

A cancer patient developed a myasthenia gravis-like syndrome after receiving a combination of immune checkpoint inhibitors.

## Contribution

Reports a novel case of severe autoimmune-like toxicity from a specific ICI combination in urothelial carcinoma.

## Key findings

- The patient experienced severe multisystem autoimmune-like toxicity.
- Myasthenia gravis-like syndrome was observed with the ICI combination therapy.
- Combined immunotherapy may increase the risk of systemic and neurological autoimmunity.

## Abstract

The widespread use of immune checkpoint inhibitors (ICIs) for the treatment of various types of cancer has led to increasing reports of associated adverse effects. The use of the ipilimumab/nivolumab/sacituzumab combination is currently under study in patients with metastatic urothelial carcinoma, given their potential synergism for immunogenic cell death. Information regarding the toxicity spectrum of this combination is lacking. Here, we describe a patient with urothelial carcinoma who had a severe multisystem autoimmune-like toxicity and myasthenia gravis-like syndrome in response to the ipilimumab/nivolumab/sacituzumab combination therapy. We also briefly describe the literature regarding the association between combined immunotherapy use and systemic and neurological autoimmunity.