2023 年第 11 期 第 18 卷

替雷利珠单抗相关重症肌无力1例

A case report of myasthenia gravis caused by tislelizumab

作者：林新宇王爱华袁静徐珊张善超徐栩栩

英文作者：Lin Xinyu Wang Aihua Yuan Jing Xu Shan Zhang Shanchao Xu Xuxu

单位：山东第一医科大学第一附属医院（山东省千佛山医院）神经病学，神经内科山东省神经免疫研究所山东省风湿免疫病转化医学重点实验室，济南250013

英文单位：Department of Neurology the First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital) Shandong Institute of Neuroimmunology Shandong Key Laboratory of Rheumatic Disease and Translational Medicine Jinan 250013 China

关键词：重症肌无力；替雷利珠单抗；免疫检查点抑制剂

英文关键词：Myastheniagravis;Tislelizumab;Immunecheckpointinhibitors

• 摘要：

• 免疫检查点抑制剂(ICIs)相关的重症肌无力（MG）是一种罕见且致命的免疫相关不良事件。本文报道1例53岁男性膀胱尿路上皮癌患者接受替雷利珠单抗治疗第35天出现左侧眼睑下垂，视物成双，并逐渐进展出现右侧眼睑下垂及四肢无力，辅助检查提示血清乙酰胆碱受体抗体阳性，肌电图提示面神经、副神经、尺神经在低频刺激下可见明显递减现象，诊断“替雷利珠单抗相关MG”，给予溴吡斯的明、免疫球蛋白及醋酸泼尼松片治疗，四肢无力症状消失，患者出院后规律口服药物，3个月后随访，患者眼睑下垂、视物成双及肢体无力症状基本消失。临床应用替雷利珠单抗治疗恶性肿瘤出现ICIs相关MG的不良反应时，应高度警惕，早期诊断和治疗可能获得良好效果。

• Myasthenia gravis (MG) associated with immune checkpoint inhibitors (ICIs) is one of rare and fatal immune-related adverse events. This paper reported a 53-year-old male patient with urothelial bladder carcinoma who developed left eyelid ptosis and double vision on day 35 of the tislelizumab treatment. Subsequently, the symptoms developed with right eyelid ptosis and limb weakness. The serum acetylcholine receptor antibody was positive, and the electromyogram demonstrated that the facial nerve, accessory nerve, and ulnar nerve were significantly decreased under low-frequency stimulation and diagnosed as tislelizumab-associated MG. After treatment with bromidesteramine, immunoglobulins, and prednisone acetate tablets, the symptoms of limb weakness disappeared. Regular oral medication after discharge, ptosis, double vision, and basically disappeared with a three-month follow-up. When adverse reactions of ICIs-associated MG occurred upon the use of tislelizumab in the treatment of malignant tumors, high vigilance, early diagnosis, and treatment might lead to good effect in the clinic.