A case of PD-1 inhibitor-induced myasthenia gravis and acute coronary syndrome: a case report

<title>Abstract</title> <p> <bold>Background</bold> This case report describes a patient who developed PD-1 inhibitor-induced myasthenia gravis (MG) and acute coronary syndrome (ACS). This condition is clinically uncommon and presents substantial management challenges, warranting attention from clinicians. <bold>Case presentation</bold> A 65-year-old man with hepatocellular carcinoma developed PD-1 inhibitor-induced MG and non-ST-segment elevation myocardial infarction (NSTEMI), presenting with diplopia, ptosis, limb weakness, elevated hs-TnT, and ST-segment depression. Although the myasthenic symptoms gradually improved after immunosuppressive therapy, the hs-TnT levels never normalized. Strikingly, seven months after the initial event, the patient suffered an acute ST-segment elevation myocardial infarction (STEMI) requiring percutaneous coronary intervention for total occlusion of the left anterior descending artery. <bold>Conclusion</bold> This course delivers an important clinical alert for patients with PD-1 inhibitor-induced MG and ACS: persistently elevated hs-TnT following neurological symptom resolution may signal ongoing coronary pathology and portend a high risk of future major adverse cardiac events, underscoring the imperative for dedicated, long-term cardiac surveillance in this population. </p>