Abstract：
An 83-year-old man with hepatocellular carcinoma developed muscle weakness, ptosis, and dyspnea 3 weeks after receiving atezolizumab. Soon after, mechanical ventilation was initiated, which was followed by marked blood pressure spikes. The levels of creatine kinase and troponin-I were significantly elevated, and acetylcholine receptor antibodies were positive. The patient was diagnosed with immune checkpoint inhibitor (ICI)-induced myositis, myasthenia gravis (MG), myocarditis, and suspected autoimmune autonomic ganglionopathy (AAG). After immunotherapy, the serum markers and blood pressure normalized, and he was weaned from the ventilator after five months. To our knowledge, this is the first reported case of AAG secondary to ICI-induced myositis, MG, and myocarditis.
摘要：
一名83岁的肝细胞癌患者出现肌肉无力，上睑下垂,接受阿特珠单抗治疗3周后出现呼吸困难。不久之后,开始机械通气，随后是明显的血压峰值。肌酸激酶和肌钙蛋白-I的水平显著升高，乙酰胆碱受体抗体呈阳性。患者被诊断为免疫检查点抑制剂（ICI）诱导的肌炎，重症肌无力（MG），心肌炎,和疑似自身免疫性自主神经节病变（AAG）。免疫治疗后，血清标志物和血压恢复正常,五个月后他从呼吸机上断奶了。据我们所知,这是第一例报告的继发于ICI诱导的肌炎的AAG病例，MG,和心肌炎.
