Double seronegative myasthenia gravis with antiphospholipid syndrome: a case report

Dan, Diana Camelia; Bart, Pierre-Alexandre; Novy, Jan; Kuntzer, Thierry; Clair, Carole (2014). Double seronegative myasthenia gravis with antiphospholipid syndrome: a case report. Journal of medical case reports, 8(2), p. 2. BioMed Central 10.1186/1752-1947-8-2

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INTRODUCTION Myasthenia gravis is an autoimmune disease characterized by fluctuating muscle weakness. It is often associated with other autoimmune disorders, such as thyroid disease, rheumatoid arthritis, systemic lupus erythematosus, and antiphospholipid syndrome. Many aspects of autoimmune diseases are not completely understood, particularly when they occur in association, which suggests a common pathogenetic mechanism. CASE PRESENTATION We report a case of a 42-year-old Caucasian woman with antiphospholipid syndrome, in whom myasthenia gravis developed years later. She tested negative for both antibodies against the acetylcholine receptor and against muscle-specific receptor tyrosine-kinase, but had typical decremental responses at the repetitive nerve stimulation testing, so that a generalized myasthenia gravis was diagnosed. Her thromboplastin time and activated partial thromboplastin time were high, anticardiolipin and anti-β2 glycoprotein-I antibodies were slightly elevated, as a manifestation of the antiphospholipid syndrome. She had a good clinical response when treated with a combination of pyridostigmine, prednisone and azathioprine. CONCLUSIONS Many patients with myasthenia gravis test positive for a large variety of auto-antibodies, testifying of an immune dysregulation, and some display mild T-cell lymphopenia associated with hypergammaglobulinemia and B-cell hyper-reactivity. Both of these mechanisms could explain the occurrence of another autoimmune condition, such as antiphospholipid syndrome, but further studies are necessary to shed light on this matter.Clinicians should be aware that patients with an autoimmune diagnosis such as antiphospholipid syndrome who develop signs and neurological symptoms suggestive of myasthenia gravis are at risk and should prompt an emergent evaluation by a specialist.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Dermatology, Urology, Rheumatology, Nephrology, Osteoporosis (DURN) > Clinic of Rheumatology, Clinical Immunology and Allergology

UniBE Contributor:

Dan, Diana Camelia

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1752-1947

Publisher:

BioMed Central

Language:

English

Submitter:

Stefan Kuchen

Date Deposited:

06 Mar 2015 13:22

Last Modified:

26 Jun 2016 01:59

Publisher DOI:

10.1186/1752-1947-8-2

PubMed ID:

24380508

BORIS DOI:

10.7892/boris.64151

URI:

https://boris.unibe.ch/id/eprint/64151

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