# Avelumab-Induced Ocular Myasthenia Gravis: A Case Report

## TL;DR

A patient with kidney cancer developed a rare neurological condition after treatment with avelumab, highlighting the need for early detection and teamwork in managing such side effects.

## Contribution

This case report presents a rare instance of avelumab-induced ocular myasthenia gravis in a patient with metastatic renal cell carcinoma.

## Key findings

- The patient developed bilateral ptosis and ophthalmoplegia without typical MG symptoms like limb weakness.
- Treatment with pyridostigmine and steroids managed symptoms, but avelumab was discontinued due to recurrence.
- The case emphasizes the importance of multidisciplinary management in immune checkpoint inhibitor-related adverse events.

## Abstract

Avelumab, a programmed death-ligand 1 (PD-L1) inhibitor, has shown efficacy in renal cell carcinoma (RCC) but is associated with immune-related adverse events (irAEs), including rare neurological complications such as myasthenia gravis (MG). We report a case of a 75-year-old male patient with metastatic RCC receiving avelumab and axitinib who developed bilateral ptosis and ophthalmoplegia. Notably, there were no swallowing difficulties, limb weakness, or sensory deficits. The patient was treated with pyridostigmine and a weaning course of steroids per neurology input. Avelumab was eventually stopped due to the recurrence of symptoms. This case highlights the importance of early recognition and management of immune checkpoint inhibitor-induced MG to balance oncologic benefits with potential toxicities while also underlining the value of a multidisciplinary team (MDT) approach.