Lupus eritematoso sistêmico associado a miastenia gravis: relato de caso

Carvalho, Marcio F. De; Abrahão, Teresa C. M.; Assaf, Mounir

doi:10.1590/s0004-282x1998000100025

Cited by 3 publications

(1 citation statement)

References 10 publications

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“…6,7 The prevalence of SLE in patients with MG ranges from 2.2% to 8.3%; however, the prevalence of MG in patients with SLE remains unknown. 5,8 This statistics may be higher, because the use of immunosuppressants in the treatment of MG may mask SLE development. 3,9 This study aimed at reporting one case of MG in a patient previously diagnosed with SLE according to the American College of Rheumatology criteria.…”

Section: Introductionmentioning

confidence: 99%

Lúpus Eritematoso Sistêmico com fraqueza muscular por Miastenia Gravis

Studart¹,

Rodrigues²,

Soares³

et al. 2011

Rev. Bras. Reumatol.

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Systemic lupus erythematosus (SLE) and myasthenia gravis (MG) are autoimmune diseases, whose association in the same patient is rarely reported. Both pathologies share the following characteristics: affect mainly young women; alternate exacerbation and remission periods; and have positive antinuclear antibody (ANA) test. This case report assesses possible diagnostic hypotheses for the clinical fi ndings of eyelid ptosis and proximal muscle weakness in a female patient recently diagnosed with SLE, who evolved with associated MG.

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Section: Introductionmentioning

confidence: 99%

Lúpus Eritematoso Sistêmico com fraqueza muscular por Miastenia Gravis

Studart¹,

Rodrigues²,

Soares³

et al. 2011

Rev. Bras. Reumatol.

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Long-term immunologic effects of thymectomy in patients with myasthenia gravis

Gerli¹,

Paganelli²,

Cossarizza³

et al. 1999

Journal of Allergy and Clinical Immunology

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Myasthenia gravis and multiple sclerosis: an uncommon presentation

Lorenzoni

Scola

Kay

et al. 2008

Arq. Neuro-Psiquiatr.

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Myasthenia gravis (MG) is an autoimmune disease that compromises neuromuscular transmission and is mediated by autoantibodies against acetylcholine receptors on the postsynaptic membrane 1 . In its usual form it leads to symptoms of decreased muscle strength and fatigue 1 . Multiple sclerosis (MS) is an immune-mediated demyelinating disease of the central nervous system that shows a wide range of clinical features and a variable natural history 2 . There is some evidence that patients with MG or MS have a higher risk of developing autoantibodies and other neuroimmune disorders than normal controls 3,4 . An autoimmune pathogenesis is implicated in both MG and MS, but the coexistence of the two disorders has rarely been documented, and for this reason we report this case 4 . CASEA 28-year-old woman presented with diplopia, dysphagia and mild limitation of ocular movements, with progressive palpebral ptosis and weakness, which changed in intensity from day to day and during the day according to the patient's physical activity.Physical examination did not reveal any abnormalities. On neurological examination she was found to have asymmetrical palpebral ptosis (left>right); symmetrical muscle weakness (grade 4 on the MRC scale) in the proximal upper and lower limbs; and deep tendon reflexes. Gait and all sensory examinations were normal.The investigation yielded the following results: (1) positive anti-acetylcholine receptor antibody test (14.91 nmol/L; normal < 0.20 nmol/L); (2) normal needle electromyography and nerve conduction studies; (3) repetitive stimulation of the facial, spinal accessory and ulnar nerves at 3 Hz with a decrement of more than 10% in compound muscle action potential amplitude (Fig 1); and (4) improvement of symptoms after treatment with pyridostigmine (180 mg daily). Chest computed tomography scan was normal.A diagnosis of MG was made, and the patient showed an improvement in symptoms after she started to receive prednisone and pyridostigmine. Prednisone was discontinued after one year and was followed by oral administration of azathioprine (100 mg/day), with an improvement in palpebral ptosis and muscle strength (grade 5 on the MRC scale).When she was 32 years old and still on azathioprine treatment, the patient developed a sudden weakness in her left lower limb and was treated with prednisone (60 mg/day). After this new neurological manifestation suggestive of MS, the patient was submitted to brain magnetic resonance imaging (MRI), which revealed multiple areas of high signal on FLAIR and T2-weighted images in the periventricular and subcortical white matter of the brain hemispheres (Fig 2A).

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Lupus eritematoso sistêmico associado a miastenia gravis: relato de caso

Cited by 3 publications

References 10 publications

Lúpus Eritematoso Sistêmico com fraqueza muscular por Miastenia Gravis

Lúpus Eritematoso Sistêmico com fraqueza muscular por Miastenia Gravis

Long-term immunologic effects of thymectomy in patients with myasthenia gravis

Myasthenia gravis and multiple sclerosis: an uncommon presentation

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