Atezolizumab-induced neuromuscular syndrome mimicking myasthenia gravis in a patient with hepatocellular carcinoma - an area of concern.

Abstract

Background: Atezolizumab is an immune checkpoint inhibitor that has been approved for several neoplasms including advanced hepatocellular carcinoma. It is also capable of inducing adverse events involving the nervous system in susceptible individuals.

Case presentation: We report a case of myasthenia gravis, occurring in a 64-year-old patient diagnosed with hepatocellular carcinoma, who within a few months of the first-line combination use of Atezolizumab and Bevacizumab, developed worsening muscular weakness. She was managed with plasma exchange and intravenous immunoglobulin with minimal response initially, but later on, deteriorated and succumbed to the condition.

Conclusion: Although uncommon, the use of Atezolizumab can either give rise to or worsen a pre-existing, latent neurological condition. These neurological immune-mediated adverse events can prove to be debilitating or even life-threatening if not timely treated, thus warranting prompt investigation by the physicians for proper diagnosis and management.