[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-355849-105":59,"doc-detail-355849-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","severe-immune-checkpoint-inhibitor-induced-3m-syndrome-a-case-report","Severe immune checkpoint inhibitor-induced 3M syndrome - A case report","","Severe immune checkpoint inhibitor (ICI) treatment can trigger immune-related adverse events, including immune myocarditis, which becomes especially lethal when combined with myositis and myasthenia gravis to form 3M syndrome. A 65-year-old woman with stage FIGO IIIA cervical squamous cell carcinoma received anti-PD-1 therapy with chemoradiotherapy, followed by early neuromuscular signs. Within days, cardiac deterioration and elevated biomarkers confirmed ICI-induced 3M syndrome, yet she died after progressive respiratory failure despite high-dose corticosteroids, IVIG, and mycophenolate.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/severe-immune-checkpoint-inhibitor-induced-3m-syndrome-a-case-report/355849/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/severe-immune-checkpoint-inhibitor-induced-3m-syndrome-a-case-report/355849.png","ImageObject",300,407,{"name":92,"@type":93},"Grenda","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-29","2026-09-22",true,{"@type":102,"interactionType":103,"userInteractionCount":39},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What is 3M syndrome in the context of immune checkpoint inhibitors?","Question",{"text":112,"@type":113},"3M syndrome refers to the fatal overlap of immune myocarditis with myositis and myasthenia gravis after immune checkpoint inhibitor therapy. It is characterized by early onset and rapid deterioration.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What symptoms signaled early neuromuscular involvement before cardiac failure?",{"text":117,"@type":113},"The patient developed subtle neuromuscular symptoms, including ptosis and facial weakness, before the sudden onset of chest tightness and acute heart failure.",{"name":119,"@type":110,"acceptedAnswer":120},"How was ICI-induced 3M syndrome diagnosed in this case?",{"text":121,"@type":113},"Diagnosis was supported by concurrent elevations of cardiac biomarkers and creatine kinase, together with neuromuscular involvement consistent with ICI-induced 3M syndrome.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},355849,1790363888,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":39,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":29,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144},7971474921005,"https://ap-avatar.wpscdn.com/davatar_29158cc5080c5b710cf443261637dec0","TYPE Case Report  \nPUBLISHED 29 May 2026  \nDOI 10.3389/fimmu.2026.1840526  \nOPEN ACCESS  \nEDITED BY  \nJeffrey J. Pu,  \nTufts University, United States  \nREVIEWED BY  \nJen-Jen Su,  \nNational Taiwan University Hospital, Taiwan  \nYasmin Abozenah,  \nTampa General Hospital, United States  \n*CORRESPONDENCE  \nShikai Liu  \n [lf56748@163.com](lf56748@163.com)  \nRECEIVED 27 March 2026  \nREVISED 09 May 2026  \nACCEPTED 19 May 2026  \nPUBLISHED 29 May 2026  \nCITATION  \nYao H, Hao Z, Zhang X and Liu S (2026) Severe immune checkpoint inhibitorinduced 3M syndrome: a case report.  \nFront. Immunol. 17:1840526 .  \ndoi: 10.3389/fimmu.2026.1840526  \nCOPYRIGHT  \n© 2026 Yao, Hao, Zhang and Liu. This isan open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.  \nSevere immune checkpoint inhibitor-induced 3M syndrome:  \na case report  \nHairong Yao, Zitong Hao, Xin Zhang and Shikai Liu*  \nDepartment of Gynecologic Oncology, Cangzhou Central Hospital, Cangzhou, Hebei, China  \nBackground: Immune checkpoint inhibitors (ICIs) have significantly improved survival rates in various advanced cancers, including cervical cancer. However, they can induce a range of immune-related adverse events (irAEs), with immune myocarditis being particularly dangerous, especially when combined with myositis and myasthenia gravis, forming the fatal 3M syndrome. Early symptoms are subtle, and delayed diagnosis and treatment often lead to severe consequences.  \nCase presentation: A 65-year-old female with stage FIGO stage IIIA cervical squamous cell carcinoma received one dose of anti-PD-1 monoclonal antibody (Enlarzumab) combined with chemoradiotherapy. Following initial disease stabilization, the patient developed early neuromuscular symptoms, including ptosis and facial weakness, on Day 21 . By Day 25, she experienced sudden chest tightness and acute heart failure with new-onset atrial fibrillation and a decline in left ventricular ejection fraction from 57% to 40% . The concurrent elevation of cardiac biomarkers and creatine kinase, alongside neuromuscular involvement, confirmed the clinical diagnosis of ICI-induced 3M syndrome. Despite treatment with high-dose methylprednisolone, intravenous immunoglobulin (IVIG), and mycophenolate mofetil, the patient ultimately succumbed to progressive respiratory failure following the family ’s decision to decline further invasive respiratory support.  \nConclusion: This case highlights the insidious onset and rapid progression of 3M syndrome, where neuromuscular symptoms often serve as overlooked precursors to myocarditis. Establishing a systematic approach involving proactive monitoring and immediate immunosuppressive treatment is essential to ensure the safety of immunotherapy.  \nKEYWORDS  \n3M syndrome, cervical cancer, early monitoring, immune checkpoint inhibitorassociated myocarditis, immune checkpoint inhibitors  \nIntroduction  \nImmune checkpoint inhibitors (ICIs), particularly those targeting programmed cell death protein 1 (PD-1) and its ligand PD-L1, have transformed the therapeutic landscape of advanced cervical cancer, offering meaningful survival benefits for patients with recurrent or metastatic disease (1) . By restoring T-cell–mediated antitumor immunity, these agents improve clinical outcomes but may also disrupt immune tolerance. This can lead to immune-related adverse events (irAEs) affecting multiple organs; among these, the overlap of neuromuscular and cardiovascular toxicities is particularly life-threatening (2) .  \nFrontiers in Immunology 01 [frontiersin.org](frontiersin.org)  \nAlthough cardiovascular irAEs are relatively uncommon, with an esti","cbCaiuYwhVKehu2b","https://ap.wps.com/l/cbCaiuYwhVKehu2b","pdf",1772814,"English","# Introduction\n## Case presentation\n### Patient information and baseline assessment\n### Treatment course and clinical deterioration\n## Conclusion","[{\"question\":\"What is 3M syndrome in the context of immune checkpoint inhibitors?\",\"answer\":\"3M syndrome refers to the fatal overlap of immune myocarditis with myositis and myasthenia gravis after immune checkpoint inhibitor therapy. It is characterized by early onset and rapid deterioration.\"},{\"question\":\"What symptoms signaled early neuromuscular involvement before cardiac failure?\",\"answer\":\"The patient developed subtle neuromuscular symptoms, including ptosis and facial weakness, before the sudden onset of chest tightness and acute heart failure.\"},{\"question\":\"How was ICI-induced 3M syndrome diagnosed in this case?\",\"answer\":\"Diagnosis was supported by concurrent elevations of cardiac biomarkers and creatine kinase, together with neuromuscular involvement consistent with ICI-induced 3M syndrome.\"}]","Severe immune checkpoint inhibitor-induced 3M syndrome - A case report | PDF",1790121312,15]