{
  "abstract": "A 64-year-old male with Stage III urothelial carcinoma of the right ureter presented to the emergency department 3 weeks after a single cycle of combined enfortumab vedotin and pembrolizumab with chest tightness, neck weakness, drop head, and myalgias. Laboratory findings included markedly elevated high-sensitivity troponin I, creatine phosphokinase, lactate dehydrogenase, and transaminases. Electrocardiography showed anterolateral ST depression and left anterior fascicular block, which was new as compared to a prior tracing. He was managed in the cardiovascular intensive care unit. Cardiac catheterization revealed concurrent 90% mid-left anterior descending artery stenosis, treated with drug-eluting stent placement. Endomyocardial biopsy confirmed focal moderate lymphocytic myocarditis. Cardiac MRI demonstrated mildly reduced biventricular function and a non-ischemic pattern of late gadolinium enhancement consistent with myocarditis sequelae. Given the overlapping multisystem presentation, a multidisciplinary team (cardiology, neurology, and oncology) elected to treat with high-dose methylprednisolone (1 g QOD x 5 days), the guideline-recommended first-line therapy for ICI-associated myocarditis, and intravenous immunoglobulin (400 mg/kg QOD x 5 days), with biochemical improvement. IVIG was added given clinical concern for possible neuromuscular junction involvement in the setting of concurrent myositis and possible overlap syndrome, reflecting a precautionary approach to a potentially rapidly progressive presentation. Myasthenia gravis was considered but not confirmed: repeated neurological examinations demonstrated no fatigable weakness, and serology was negative for acetylcholine receptor binding and muscle-specific kinase antibodies. Both implicated agents were permanently discontinued. This case illustrates the spectrum and severity of multisystem immune-related toxicity from combined antibody-drug conjugate and immune checkpoint inhibitor therapy.",
  "abstract_shown": true,
  "affiliations": [
    "Anesthesia, University of South Florida Morsani College of Medicine, Tampa, USA.",
    "Internal Medicine, Jawaharlal Nehru Medical College, Ajmer, IND."
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 2,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Bryan Ashong"
    },
    {
      "affs": [
        1
      ],
      "name": "Yash Ranga"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/3gak4cfb91y9d.bib",
  "cited_by": 0,
  "doi": "10.7759/cureus.116849",
  "fulltext_url": "https://europepmc.org/articles/PMC13695431",
  "id": "3gak4cfb91y9d",
  "issns": [
    "2168-8184"
  ],
  "landing_url": "https://europepmc.org/article/MED/42927390",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2730|Cancer Immunotherapy and Biomarkers"
    ]
  ],
  "openalex": "W7214184080",
  "pdf_url": "https://europepmc.org/articles/PMC13695431?pdf=render",
  "pmcid": "PMC13695431",
  "pmid": "42927390",
  "published": "2026-09-24",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/3gak4cfb91y9d.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:21:18Z",
      "native_id": "MED:42927390",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42927390"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2730|Cancer Immunotherapy and Biomarkers",
      "subfield": "oncology"
    }
  ],
  "title": "Confirmed Myocarditis-Myositis Overlap Without Myasthenia Gravis: Evaluating for Triple M Syndrome Following Combined Enfortumab Vedotin and Pembrolizumab Therapy.",
  "title_text": "Confirmed Myocarditis-Myositis Overlap Without Myasthenia Gravis: Evaluating for Triple M Syndrome Following Combined Enfortumab Vedotin and Pembrolizumab Therapy.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:21:18Z",
  "url": "https://research.draconitic.com/paper/3gak4cfb91y9d",
  "venue": "Cureus",
  "versions": []
}