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General Rehabilitation

Immune Checkpoint Inhibitor Induced Dermatomyositis in an endometrial carcinoma patient

Thursday, October 23, 2025
12:45 PM - 2:15 PM MT
Location: Kiosk 2
Has Audio

    Primary Author(s)

  • Victoria A. Jenifer

    Medical Student
    University of Miami- Miller School of Medicine
    McDonough, Georgia

  • DW

    Daniel Wang, DO

    Resident Physician
    University of Miami/Jackson Health System PM&R Program
    Gaithersburg, Maryland

    • Co-Author(s)

  • Diana Molinares-Mejia, MD

    Cancer Rehabil Director. Residency Program Director
    University of Miami/Jackson Health System PM&R Program
    Miami, Florida

  • GA

    Gemayaret Alvarez, MD

    Associate Professor
    University of Miami Health System
    Miami, Florida

Disclosure(s):
Victoria A. Jenifer: No financial relationships to disclose
Diana Molinares-Mejia, MD: No financial relationships to disclose
Case Diagnosis: A 61-year-old woman with endometrial carcinoma experienced Immune Checkpoint Inhibitor Induced dermatomyositis following chemotherapy.

Case Description or Program Description: A 61-year-old female with stage 3C2 endometrial carcinoma presented with proximal muscle weakness, dysphagia, fatigue, and a rash three weeks status post round two of adjuvant systemic chemotherapy (Carboplatin, Taxol, and Programmed Cell Death Protein 1 inhibitor Dostarlimib). Blood work revealed increasing CPK and aldolase levels. Positive Anti-transcription intermediary factor 1 antibodies confirmed the diagnosis of Immune Checkpoint Inhibitor (ICI) induced dermatomyositis with seronegative myasthenia gravis (MG). Her case was complicated by a right ACA stroke, causing residual left-sided weakness. After initiating IV Solumedrol, plasma exchange, and pyridostigmine, she was medically stable and discharged from Gyn-Oncology to inpatient rehabilitation.

Setting: Rehabilitation Center Inpatient Unit

Assessment/Results: On admission, she continued pyridostigmine and oral prednisone with subjective improvements in strength occurring about six weeks post-final exposure to Dostarlimib. She initially had difficulty ambulating, swallowing, and standing from sitting. However, after extensive work with PT, OT, SLP, and steroids, her functional scores improved from 64 to 94. She improved most in toileting hygiene (3 to 6) and showed a 1-point improvement in gait mobility.

Discussion (relevance): ICI-induced myositis causes functional impairments including gait disturbance and bowel and bladder incontinence - highlighting the importance of including a physiatrist in these patients' care. The incidence of ICI-induced myositis has been reported at 0.40% among cancer patients, and in some cases can be fatal. Treatment involves discontinuing the ICI and management with corticosteroid therapy. Intravenous immunoglobulin and plasmapheresis are reserved for severe cases. From the rehabilitation standpoint, approximately 25% of the patients have found to need admission to acute inpatient rehabilitation with a median gain of 16 functional points.

Conclusions: ICI-DM is a rare but potentially fatal complication of immunotherapy oncological regimens. Thus, a low threshold of suspicion is imperative for the identification and management of the condition.