CASE REPORT article
Front. Immunol.
Sec. Autoimmune and Autoinflammatory Disorders : Autoimmune Disorders
Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1661534
An Atypical Presentation of Immune Checkpoint Inhibitor Associated Myositis with Normal Creatine Kinase: A Case Series
Provisionally accepted
Monika A Satoskar*
Anthony G Mansour
Richard WuYuanquan Yang
Miriam L FreimerMary H Caldwell
Alexa Meara- Wexner Medical Center, The Ohio State University, Columbus, United States
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Immune checkpoint inhibitors (ICIs) have been revolutionary in the field of cancer therapeutics. Myositis is a known rheumatic immunotherapy related adverse event with a fatality rate of 26.8% when associated with myasthenia gravis and 51.3% when associated with myocarditis. Typically, creatine kinase (CK) is elevated in ICI-myositis, thus normal CK levels in such cases may delay diagnosis and treatments in such patients. We report 2 cases of patients diagnosed with ICI-myositis after ipilimumab/nivolumab treatment for metastatic renal cell carcinoma and metastatic melanoma. Their lab studies showed normal CK values but elevated aldolase, which led to the ICI-myositis diagnosis and steroid treatment. Early recognition and treatment with steroids led to symptom improvement. These 2 cases highlight an atypical presentation of ICI-myositis with normal CK but elevated aldolase levels, suggesting aldolase may be a sensitive parameter in diagnosing ICI-myositis.
Keywords: Immunotherapy, Immune checkpoint inhibitor, Myositis, Immune-related adverse event, aldolase, Creatine kinase (CK)
Received: 09 Jul 2025; Accepted: 24 Sep 2025.
Copyright: © 2025 Satoskar, Mansour, Wu, Yang, Freimer, Caldwell and Meara. 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: Monika A Satoskar, monika.satoskar@osumc.edu
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