Work

Immune Checkpoint Inhibitor-Induced Myocarditis, Myositis, and Concern for 3-Ms Syndrome in a Patient With Metastatic Melanoma: A Case Report

Year: 2025

Type: article

Abstract: Immune checkpoint inhibitors (ICIs), including ipilimumab and nivolumab, have revolutionized treatment for advanced malignancies such as metastatic melanoma. While effective, these agents can trigger immune-related adverse events (irAEs) that may involve multiple organ systems. Myocarditis, myositis, and myasthenia gravis - collectively referred to as the "3 Ms" overlap syndrome - are rare but potentially fatal irAEs. These conditions can present concurrently, often with nonspecific symptoms, making diagnosis challenging and potentially delayed. This case describes a 79-year-old male with stage IV metastatic melanoma who developed myocarditis and myositis following a single cycle of combination ICI therapy, with clinical features raising concern for an overlapping myasthenia-like syndrome, although a definitive diagnosis was not made. Early recognition and prompt initiation of high-dose corticosteroids resulted in clinical improvement and stabilization. This case underscores the importance of maintaining a high index of suspicion for severe irAEs in patients receiving ICIs, as timely intervention is critical to preventing life-threatening complications.

Source: Cureus

DOI: 10.7759/cureus.92973

Authors: Jad Daw, Michael J Padron, Ishaan Dutta, Hunter Stecko, Abdo Haddad

Institutions: Cleveland Clinic, Liberty University, The Ohio State University Wexner Medical Center

Language: English

Topic: Cancer Immunotherapy and Biomarkers

Subfield: Oncology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

OpenAlex ID: W4414413123