Pembrolizumab-induced ocular Myasthenia Gravis with anti-titin antibody and necrotizing myopathy

Asako Onda, Shinji Miyagawa, Naoko Takahashi, Mina Gochi, Masamichi Takagi, Ichizo Nishino, Shigeaki Suzuki, Chizuko Oishi, Hiroshi Yaguchi

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20 Citations (Scopus)


A 73-year-old man developed diplopia after the administration of pembrolizumab for lung adenocarcinoma. He had ptosis and external ophthalmoplegia without general muscle weakness. Serum CK levels were elevated. Although autoantibodies to acetylcholine receptor and muscle-specific kinase, the edrophonium test, and the repetitive nerve stimulation test were all negative, anti-titin autoantibody was positive, leading to the diagnosis of myasthenia gravis (MG). Muscle pathology showed necrotizing myopathy with tubular aggregates. Unlike previously reported cases of pembrolizumab-associated MG, the present case showed ocular MG. This is the first case of pembrolizumab-associated MG with anti-titin antibody, as well as the first case with tubular aggregates.

Original languageEnglish
Pages (from-to)1635-1638
Number of pages4
JournalInternal Medicine
Issue number11
Publication statusPublished - 2019


  • Anti-titin antibody
  • Necrotizing myopathy
  • Ocular myasthenia gravis
  • Pembrolizumab
  • Tubular aggregates

ASJC Scopus subject areas

  • Internal Medicine


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