SHM Converge Scientific Abstract ePoster Gallery-A Rare Case of Inflammatory Myositis Associated With Durvalumab Plus Tremelimumab in HCC

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This document is a conference poster summarizing a rare case of immune checkpoint inhibitor (ICI)-associated inflammatory myositis in a 65-year-old man with hepatocellular carcinoma treated with durvalumab plus tremelimumab. Five weeks after his first treatment cycle, he developed diffuse muscle pain, proximal weakness, rash, and urinary/fecal incontinence. Exam showed shoulder weakness and characteristic violaceous/erythematous rashes. Labs revealed markedly elevated AST/ALT, troponin, CK, and aldolase, raising concern for severe immune-related toxicity.<br /><br />Extensive workup helped exclude other causes and associated complications: EKG and echocardiography did not suggest ischemia, cardiac MRI ruled out myocarditis, spine MRI excluded cord compression, and EMG showed a myopathic process. Autoantibody testing was largely negative except for elevated anti-striation antibodies. MRI of both thighs demonstrated muscle atrophy and active inflammation consistent with myositis. Based on published diagnostic criteria, the patient met three minor criteria for ICI-related myositis, confirming the diagnosis without biopsy.<br /><br />Because he also had grade 4 immune-mediated hepatitis, immunotherapy was discontinued. He was treated promptly with high-dose intravenous methylprednisolone followed by oral prednisolone taper. His muscle pain, weakness, and fecal incontinence improved rapidly, with hospital-day-4 resolution of major symptoms and urinary incontinence resolving three weeks later.<br /><br />The poster emphasizes that durvalumab and tremelimumab can cause severe immune-mediated myositis, sometimes with dangerous overlap syndromes such as myocarditis or myasthenia gravis. Clinicians should maintain a high index of suspicion, recognize symptoms early, stop immunotherapy, and begin corticosteroids quickly to reduce morbidity and prevent fatal outcomes.

Asset Subtitle

Soniya Abraham

Meta Tag

Author List Charles M. Cook, Jay Parekh, Naga Venkata Rama Krishna Vura, Neha Sharma, Soniya Abraham

Category Clinical Vignettes

Concept Immune Checkpoint Inhibitor

Concept Myositis

Concept Immune-Mediated Myositis

Concept Proximal Weakness

Concept High-Dose Corticosteroid

Distinguished Non-Finalist

Presenter Organization Uthscsa

Presenting Author Soniya Abraham

Track Adult

Keywords

immune checkpoint inhibitor

inflammatory myositis

durvalumab

tremelimumab

hepatocellular carcinoma

immune-related toxicity

corticosteroid treatment

myocarditis exclusion

anti-striation antibodies

grade 4 hepatitis

Immune Checkpoint Inhibitor

Myositis

Immune-Mediated Myositis

Proximal Weakness

High-Dose Corticosteroid