Case Report: Immune checkpoint inhibitor-associated myocarditis, myositis, and myasthenia gravis overlap syndrome with flow cytometric phenotyping before and after treatment in a patient with urothelial carcinoma - Takeaways - MDSpire

Case Report: Immune checkpoint inhibitor-associated myocarditis, myositis, and myasthenia gravis overlap syndrome with flow cytometric phenotyping before and after treatment in a patient with urothelial carcinoma

  • By

  • Karen Gambina

  • Carly Tymm

  • Matthieu Paiola

  • Kurenai Tanji

  • John Zech

  • Robert Winchester

  • Adam Mor

  • Yevgeniya Gartshteyn

  • June 15, 2026

  • 0 min

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  • 1

    Immune checkpoint inhibitor-associated myocarditis, myositis, and myasthenia gravis overlap syndrome (IM3OS) is a severe immune-related adverse event.

  • 2

    A 77-year-old woman developed IM3OS after receiving nivolumab for high-grade invasive urothelial carcinoma, presenting with weakness and dysarthria.

  • 3

    The patient was successfully treated with high-dose glucocorticoids, mycophenolate mofetil, and intravenous immunoglobulin, leading to symptom resolution.

  • 4

    Flow cytometric analysis revealed an expansion of memory CD8+ T-cells and a differentiated CD4+ subset associated with clinical disease activity.

  • 5

    The study highlights the potential of flow cytometry to understand the pathophysiology of immune-related adverse events and guide treatment.

Original Source(s)

Case Report: Immune checkpoint inhibitor-associated myocarditis, myositis, and myasthenia gravis overlap syndrome with flow cytometric phenotyping before and after treatment in a patient with urothelial carcinoma

  • by Karen Gambina, Carly Tymm, Matthieu Paiola, Kurenai Tanji, John Zech, Robert Winchester, Adam Mor, Yevgeniya Gartshteyn

  • June 15, 2026

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