ArticleJACC. Case reports2025
Myocarditis, Myositis, and Myasthenia Gravis: The Complexities of Treating Steroid-Refractory Triple M Syndrome.
Article in JACC. Case reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Triple M Overlap Syndrome After Immune Checkpoint Inhibitors: A Case Series of a High-Mortality Phenotype.JACC. Case reports · 2026Article
- Progressive Conduction Disease on Serial ECGs Revealing Immune Checkpoint Inhibitor-Associated Myocarditis and Myositis.JACC. Case reports · 2026Article
- Article
- Triple M Syndrome Associated With Concurrent Durvalumab and Olaparib Therapy in Metastatic Cholangiocarcinoma: A Case Report.Case reports in oncological medicine · 2026Article
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundTriple M syndrome is the combination of myocarditis, myositis, and myasthenia gravis secondary to immune checkpoint inhibitor (ICI) treatment. Traditionally managed with high-dose steroids, ICI myocarditis may benefit from early initiation of nonsteroidal immunosuppression. CASE SUMMARY: A man with hepatocellular carcinoma presented with double vision and an elevated high-sensitivity troponin after receiving his first dose of tremelimumab (CTLA-4 inhibitor) and durvalumab (PD-L1 inhibitor). He was diagnosed with steroid-refractory ICI myocarditis and treated with abatacept and ruxolitinib. Early recognition of triple M syndrome and initiation of nonsteroidal immunosuppression are described. DISCUSSION: Management of ICI myocarditis is evolving. Nonsteroidal immunosuppression may become an essential component of management as ICI use, and therefore occurrence of triple M syndrome, increases. TAKE-HOME MESSAGES: If there is recent initiation of ICI therapy, elevated troponin, and concomitant ICI toxicities, providers should suspect ICI myocarditis despite negative cardiac magnetic resonance imaging. Nonsteroidal immunosuppression with CTLA-4 agonists may be effective in patients treated with CTLA-4 inhibitors.
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