CASE REPORT article
Front. Immunol.
Sec. Cancer Immunity and Immunotherapy
Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1592385
This article is part of the Research TopicCancer Therapy Related Organ ToxicitiesView all 8 articles
A Rare Case Report: Immune Checkpoint Inhibitor-Induced Myositis Without Elevated Creatine Kinase
Provisionally accepted
- Department of Dermatology, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Rhineland-Palatinate, Germany
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Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of advanced cancers like malignant melanoma. However, they can lead to a range of immune-related adverse events (irAEs), impacting various organ systems. Among these, myositis is a rare but serious irAE, typically characterized by myalgia, muscle weakness, and elevated creatine kinase (CK) levels. Herein, we report the case of a 58-year-old female with advanced melanoma, who presented a delayed-onset of ICI-induced myositis accompanied by severe muscle weakness. Interestingly, the CK levels remained normal throughout her disease course. Neurological examination, MRI, and electromyography were pivotal in diagnosing myositis. Differential diagnoses, including myasthenia gravis, myocarditis, and paraneoplastic syndromes or idiopathic inflammatory myopathies, were systematically ruled out through clinical evaluation, serological testing, and imaging. The patient responded favorably to high-dose corticosteroid therapy, leading to a gradual improvement of symptoms and no relapse after stopping treatment. This case report emphasizes a multimodal diagnostic approach and underscores the importance of clinical awareness for such atypical irAE presentations.
Keywords: Immune-related adverse events (IRAE), Myositis, immune checkpoint inhibitors, Creatine Kinase, Melanoma, case report
Received: 12 Mar 2025; Accepted: 09 Jun 2025.
Copyright: © 2025 Begaj, Wilhelm, Lepper, Veeser, Kaufhold, Grabbe and Stege. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Klajdi Begaj, Department of Dermatology, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, 55131, Rhineland-Palatinate, Germany
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