Lambert-Eaton Myasthenic Syndrome Recurrence Induced by Pembrolizumab in a Patient with Non-small-cell Lung Cancer

Yuki Takigawa; Hiromi Watanabe; Yoshio Omote; Sunao Kurihara; Tomoyoshi Inoue; Miho Fujiwara; Sho Mitsumune; Kiriko Onishi; Kenichiro Kudo; Akiko Sato; Ken Sato; Keiichi Fujiwara; Takuo Shibayama

doi:10.2169/internalmedicine.0072-22

This article has now been updated. Please use the final version.

Lambert-Eaton Myasthenic Syndrome Recurrence Induced by Pembrolizumab in a Patient with Non-small-cell Lung Cancer

Yuki Takigawa, Hiromi Watanabe, Yoshio Omote, Sunao Kurihara, Tomoyoshi Inoue, Miho Fujiwara, Sho Mitsumune, Kiriko Onishi, Kenichiro Kudo, Akiko Sato, Ken Sato, Keiichi Fujiwara, Takuo Shibayama

Author information

Yuki Takigawa
Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Japan
Hiromi Watanabe
Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Japan
Yoshio Omote
Department of Neurology, National Hospital Organization Okayama Medical Center, Japan
Sunao Kurihara
Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Japan
Tomoyoshi Inoue
Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Japan
Miho Fujiwara
Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Japan
Sho Mitsumune
Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Japan
Kiriko Onishi
Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Japan
Kenichiro Kudo
Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Japan
Akiko Sato
Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Japan
Ken Sato
Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Japan
Keiichi Fujiwara
Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Japan
Takuo Shibayama
Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Japan

Keywords: Lambert-Eaton myasthenic syndrome, immune checkpoint inhibitor, immune-related adverse event, non-small cell lung cancer

JOURNAL OPEN ACCESS Advance online publication

Article ID: 0072-22

DOI https://doi.org/10.2169/internalmedicine.0072-22

The final version of this article is now available: Vol. 62 (2023), No. 7 pp. 1055-1058

Details

Abstract

A 73-year-old woman in complete remission from localized small-cell lung cancer associated with Lambert-Eaton myasthenic syndrome (LEMS) 22 years earlier was referred to our hospital and diagnosed with non-small-cell lung cancer. After three courses of pembrolizumab, an immune checkpoint inhibitor, the patient complained of muscle weakness, fatigue, ptosis, and dysarthria. The anti-voltage-gated calcium channel antibody level was elevated, and waxing was observed on a high-frequency repetitive stimulation test using an electromyogram. We diagnosed her with recurrence of LEMS as an immune-related adverse event (irAE) induced by pembrolizumab. After intravenous immunoglobulin therapy, the patient's symptoms improved, and she was discharged.

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