Immune checkpoint inhibitor induced Triple-M syndrome: A case series detailing what every ophthalmologist should know
Year: 2026
Type: article
Study design: Case Report
Abstract: Purpose: Immunotherapy has revolutionized cancer treatment but has also been associated with various immune-related adverse events. Triple M syndrome is a particularly rare and life-threatening adverse effect, which encompasses the overlap of immune checkpoint inhibitor-induced myasthenia gravis, myositis, and myocarditis. In this case series, we highlight the ocular manifestations of Triple M Syndrome, which, when recognized in conjunction with other systemic symptoms, can crucially lead to early diagnosis and intervention that may help to improve patient outcomes. Observation: Patient 1, a 69 year-old woman, presented with a 1-week history of bilateral ptosis and near complete ophthalmoplegia in both eyes 2 weeks after her second dose of combination therapy of Nivolumab and Ipilimumab for renal cell carcinoma. Patient 2, an 81 year old female, presented with a 3-day history of diplopia, right-sided ptosis, and bilateral partial ophthalmoplegia 2 weeks after completing her second dose of Nivolumab for cecal adenocarcinoma. Patient 3, a 69 year-old male, presented with a 2-week history of bilateral ptosis and poor peripheral vision 4 weeks following his first dose of Durvalumab for squamous cell lung carcinoma. All 3 patients progressed to Triple M Syndrome. Conclusions and importance: Ophthalmologists may play an important role in identifying Triple M Syndrome, a rare but increasingly noted side effect of immune-checkpoint inhibitors. This case series highlights presenting symptoms that should prompt early recognition of Triple M Syndrome and also emphasizes the need for urgent referral to a multi-disciplinary care center for appropriate workup and inpatient management.
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,590
OpenAlex ID: W7223702654