Abstract：
A 61-year-old woman was treated with atezolizumab plus bevacizumab for hepatocellular carcinoma with peritoneal dissemination. Blood tests revealed elevated creatine kinase (CK) that peaked at 2,657 U/l. After two cycles of atezolizumab plus bevacizumab combination therapy, she complained of progressive dysarthria and dysphagia. Needle electromyography showed myopathic changes. Initial MRI showed high signal intensity in the orbicularis oris muscle, soft palate, tongue, pterygoid muscles, and paravertebral muscles on STIR images. Myositis-specific autoantibodies were not detected. Based on these findings, the patient was diagnosed with immune checkpoint inhibitor-associated myositis. The clinical symptoms improved after administration of oral prednisone, and follow-up MRI showed reduced extent of areas of high signal intensity and almost complete resolution of signal abnormality in the paravertebral muscles. The CK level normalized after 1 months of oral steroid administration. MRI of the head and neck, including the tongue and soft palate, may be useful in diagnosis and for evaluating therapeutic efficiency in cases of bulbar symptoms that occur following the introduction of immune checkpoint inhibitors.
摘要：
一名61岁女性接受阿特珠单抗联合贝伐单抗治疗肝细胞癌腹膜播散。血液检查显示肌酸激酶（CK）升高，峰值为2,657U/l。经过两个周期的阿替珠单抗联合贝伐单抗治疗，她抱怨进行性构音障碍和吞咽困难。针肌电图显示肌病改变。最初的MRI显示口轮匝肌的信号强度很高，软腭,舌头,翼状肌,和刺激图像上的椎旁肌肉。未检测到肌炎特异性自身抗体。基于这些发现,患者被诊断为免疫检查点抑制剂相关性肌炎.口服泼尼松后临床症状改善，随访MRI显示，高信号强度区域的范围减少，椎旁肌信号异常几乎完全消除。口服类固醇1个月后，CK水平恢复正常。头颈部核磁共振,包括舌头和软腭，在引入免疫检查点抑制剂后出现的延髓症状的情况下，可能有助于诊断和评估治疗效率。
