Immune checkpoint inhibitors (ICIs) have improved clinical outcomes with a number of advanced
malignancies. However, diverse immune-related adverse events (iRAEs) occurred with the widespread use of ICIs, some of which are rarely and life-threatening. Here we report a 66-year-old patient with
lung adenocarcinoma who received two doses of
sintilimab, a human
monoclonal antibody against programmed cell death-1 (PD-1), experienced a fatal storm of iRAEs. He was admitted to the intensive care unit (ICU) by immune induced-
myositis/
myocarditis and
rhabdomyolysis. Despite immediate immunosuppressive therapy with
methylprednisolone (MP) and
immunoglobulin intravenously, he developed into
myositis-
myasthenia gravis (MG) overlap syndrome complicated with myasthenia crisis. We commenced
plasma exchange (PLEX),
mechanical ventilation, immunosuppressive therapy, as well as other supportive
therapies. Three months later, the patient's serum
creatine phosphate kinase (CPK) and anti-
acetylcholine receptor antibody (anti-AChR-Ab) returned to normal despite
tumor progression. Herein we discuss the incidence, operating mechanism and management strategies of the fatal iRAEs. Early admission to the ICU and multidisciplinary collaborative treatment for unstable patients with iRAEs could help to achieve a favorable outcome.