The unique presentation of four immunotherapy toxicities in a single patient

Medical advancements with immunotherapy have cured some patients with previously incurable metastatic renal cancer. We present the case of a 74-year-old male metastatic renal cancer patient who received only one dose of the combination of ipilimumab with nivolumab. In response to his treatment, he developed autoimmune hepatitis, myasthenia, myositis, and myocarditis. Although these serious side effects are considered to rarely occur, they can quickly become life-threatening and even fatal. These immune-related adverse events (irAEs) may further develop into secondary life-threatening symptoms such as respiratory failure due to advanced myasthenia; cardiotoxicity of myocarditis with possible cardiogenic shock, cardiac arrest, and severe heart failure; and liver failure consequently from autoimmune hepatitis. Furthermore, the ability for physicians to detect immunotherapy toxicity early is extremely important in intervening in a timely manner to avoid lethal conditions for the patient. With patients receiving immunotherapy, communication, collaboration, and multidisciplinary care are essential. Any subtle or sudden changes in their health status or symptoms should prompt further investigation. It is our purpose to highlight this patient to raise awareness of toxicity to significantly reduce the fatality rates and increase the therapy's success rate in the years to come.