Myocarditis, Myositis, and Myasthenia Gravis: The Complexities of Treating Steroid-Refractory Triple M Syndrome.

ABSTRACT:

Background

Triple M syndrome is the combination of myocarditis, myositis, and myasthenia gravis secondary to immune checkpoint inhibitor (ICI) treatment. Traditionally managed with high-dose steroids, ICI myocarditis may benefit from early initiation of nonsteroidal immunosuppression.

Case summary

A man with hepatocellular carcinoma presented with double vision and an elevated high-sensitivity troponin after receiving his first dose of tremelimumab (CTLA-4 inhibitor) and durvalumab (PD-L1 inhibitor). He was diagnosed with steroid-refractory ICI myocarditis and treated with abatacept and ruxolitinib. Early recognition of triple M syndrome and initiation of nonsteroidal immunosuppression are described.

Discussion

Management of ICI myocarditis is evolving. Nonsteroidal i

SUBMITTER: Halloran S 

PROVIDER: S-EPMC12462124 | biostudies-literature | 2025 Aug

REPOSITORIES: biostudies-literature