Immune checkpoint inhibitor-related myasthenia gravis, myositis and myocarditis: a triad but not at the same time?

Learning points for cliniciansImmune checkpoint inhibitor-related myasthenia gravis and its overlap syndrome with myocarditis and myositis occur early after initiation of therapy and are associated with significant mortality.The clinical course of immune checkpoint inhibitor-mediated myasthenia gravis tends to be more aggressive than its de novo counterparts and management strategies must be adapted to recognize this.A window of opportunity may exist in the early stages of treatment with immune checkpoint inhibition to facilitate earlier recognition and treatment of this rare and aggressive toxicity.