Triple M Syndrome

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Muhammad Waleed, M.B.B.S.[2]

Synonyms and keywords: myocarditis with myositis and/or myasthenia gravis overlap syndrome (IM3OS)

Overview

Myocarditis-myositis-myasthenia gravis (Triple-M) overlap syndrome occurs as a rare complication in patients receiving immune checkpoint inhibitors (ICI).

Historical Perspective

Immune checkpoint inhibitors represent a form of immunotherapy that gained FDA approval in 2011. These medications are accompanied by various side effects. Among these, Triple M emerges as a rare yet lethal side effect linked to checkpoint inhibitors. The initial documented instance of Triple M occurred in 2016.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Causes by Organ System

Cardiovascular	No underlying causes
Chemical / poisoning	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	No underlying causes
Ear Nose Throat	No underlying causes
Endocrine	No underlying causes
Environmental	No underlying causes
Gastroenterologic	No underlying causes
Genetic	No underlying causes
Hematologic	No underlying causes
Iatrogenic	No underlying causes
Infectious Disease	No underlying causes
Musculoskeletal / Ortho	No underlying causes
Neurologic	No underlying causes
Nutritional / Metabolic	No underlying causes
Obstetric/Gynecologic	No underlying causes
Oncologic	No underlying causes
Opthalmologic	No underlying causes
Overdose / Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal / Electrolyte	No underlying causes
Rheum / Immune / Allergy	No underlying causes
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	No underlying causes
Dental	No underlying causes
Miscellaneous	No underlying causes

Causes in Alphabetical Order

• A...
• Z...

Make sure that each diagnosis is linked to a page.

Diagnosis

Diagnostic Criteria

If available, the diagnostic criteria are provided here.

History

A directed history should be obtained to ascertain

Symptoms

"Type symptom here" is pathognomonic of the "type disease name here".

"Type non specific symptoms" may be present.

Social History

Alcohol

The frequency and amount of alcohol consumption should be characterized.