PMC8761813_01
(A) Endoscope images showing an ulcerative neoplasia. (B) In January 2020, posttreatment CT-scan showed middle and upper esophageal carcinoma with bilateral tracheoesophageal sulcus and right supraclavicular lymph node metastasis. (C) Typical electromyogram (EMG) of deltoid muscle showing the patient's myogenic damage. (D) Timeline of diagnosis, treatment, and immune-related adverse events.
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Gastroscopy showed an ulcerative neoplasia approximately 23 cm-31 cm from the incisors ( Figure 1A ), which resulted in luminal stenosis. Initial cervical-thoracic enhanced computed tomography (CT) showed middle and upper thoracic esophageal carcinoma, suspicious invasion of the fibrous membrane surface, and multiple swollen lymph nodes in the bilateral supraclavicular region, bilateral tracheoesophageal sulcus, and mediastinum ( Figure 1B ). On electromyography, the examined muscles showed myogenic damage, and the left deltoid showed a spontaneous spot (active phase) manifestation ( Figure 1C ). Terminology Criteria for Adverse Events (CTCAE) (The order of occurrence as shown in  Figure 1D ). The patient was immediately injected with methylprednisolone sodium succinate (120 mg daily days 1-5, with gradually decreasing doses); he complained of lower extremity weakness, but his soreness was significantly improved.