Fatal Myocarditis Relapse in a Patient with Myasthenia Gravis Treated with Efgartigimod Alfa: A Case Report.
Tal Friedman Korn, Omri Zveik-Lavi, Dana Ekstein et al.
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Case in brief
A 39-year-old woman with AChR-positive generalized myasthenia gravis and a history of inflammatory myocarditis was treated with efgartigimod after inadequate response to intravenous immunoglobulin. While she experienced significant improvement in her myasthenia gravis symptoms, she developed fatal fulminant heart failure three months later, despite no skeletal muscle weakness. Emergency interventions were unsuccessful, leading to her death from anoxic brain injury.
Diagnostic / clinical pearl
Clinicians should be cautious when prescribing FcRn blockers like efgartigimod to patients with a history of myocarditis, as they may not sufficiently suppress inflammation associated with cardiac complications.
Why it matters
This case highlights the need for ongoing cardiac monitoring in myasthenia gravis patients receiving FcRn blockers, particularly those with prior myocardial involvement.