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Case Reports
. 2025 Sep 2:15:1503362.
doi: 10.3389/fonc.2025.1503362. eCollection 2025.

Surgical management of suspected paraneoplastic myasthenia gravis in rectal cancer during neoadjuvant immunotherapy: a case report

Zhiyuan Xia #  1 , Haining Chen #  1 , Ming Qiu  1 , Wei Huang  1 , Hui Li  1 , Minglin Lin  1 , Sen Zhang  1
Affiliations
Case Reports

Surgical management of suspected paraneoplastic myasthenia gravis in rectal cancer during neoadjuvant immunotherapy: a case report

Zhiyuan Xia et al. Front Oncol. .

Abstract

Colorectal cancer is among the most common malignancies of the gastrointestinal tract. Immune checkpoint inhibitors (ICIs) have become a key component in the treatment of locally advanced rectal cancer (LARC), offering promising therapeutic outcomes. However, ICIs can occasionally cause significant adverse effects. Herein, we report a case of rectal cancer with suspected paraneoplastic myasthenia gravis (pMG) induced by immune checkpoint inhibitors (ICIs). Unfortunately, the patient lacked anti-acetylcholine receptor (AChR)/muscle-specific kinase (MuSK) antibody testing and muscle biopsy, which precluded a definitive diagnosis of pMG. Remarkably, following surgical resection, the patient not only achieved complete tumor eradication but also experienced full remission of myasthenia gravis (MG).

Keywords: immune checkpoint inhibitors; locally advanced rectal cancer; neoadjuvant treatment; paraneoplastic myasthenia gravis; paraneoplastic syndrome.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Pelvic MRI of the patient pre- and post-NAT. (A) Pre-NAT. (B) Post-NAT. NAT, neoadjuvant therapy.
Figure 2
Figure 2
Trends in changes of muscle strength in the patient. (A) Trends in changes of limb and neck muscle strength. (B) Trends in changes of limb and neck muscle strength. (C) Trends in changes of upper and lower eyelid gap at rest. (D) Trends in changes of grip strength.
See this image and copyright information in PMC

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