Single-Dose Nivolumab as a Trigger of Myocarditis, Myositis, and Myasthenia Gravis Overlap Syndrome With Late Cardiac Death Despite Initial Recovery: A Case Report

14 July 2026 : Case report USA

Unusual or unexpected effect of treatment, Rare disease, Adverse events of drug therapy

Deepika Beereddy^{ABCDEF 1*}, Durga Naga Malleswara Rao Jonnalagadda^{ABCE 1}, Shobha Mandal^{CDE 2}, Jieyu Zhang^{B 1}

DOI: 10.12659/AJCR.953173

Am J Case Rep 2026; 27:e953173

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Table 1 Serial trends in troponin, creatine kinase, aspartate transaminase (AST), and alanine transaminase (ALT) during the clinical course.

	Day 0 on presentation to ED	Day 0–1 repeat labs	Day 4 start of plasmapheresis	Day 12 completion of 5 sessions of plasmapheresis	Day 15 close to discharge	2 weeks after discharge
Troponin (ng/L)	11 162	15 353*	3372	439	N/A	N/A
Creatine Kinase (IU/L)	5518*	4563	391	353	N/A	N/A
Aspartate Transaminase (AST) (IU/L)	614*	518	55	55	62	53
Alanine Transaminase (ALT) (IU/L)	497*	493	139	226	212	162
Footnotes: Day 0 is the day of presentation to the emergency department. Peak values are marked with an asterisk; all peaks occurred on Day 0. Reference ranges: high-sensitivity troponin ≥ 53 ng/L; creatine kinase 46–171 IU/L; AST < 34 IU/L; ALT 10–49 IU/L.

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