Co-occurrence of multiple sclerosis and myasthenia gravis in British C olumbia

Abstract

We describe eight patients with associated multiple sclerosis (MS) and myasthenia gravis (MG). Patients were less than 50 years old at the time of onset, and seven were female. The clinical course of both MS and MG was mild in most patients. To our knowledge, this represents the largest reported series. We provide further evidence for a nonrandom association of these two diseases and discuss common mechanisms of pathogenesis.

Demyelinating disease in patients with myasthenia gravis

“…Kister et al 9 report on 4 patients that presented recurrent NMo years after undergoing thymectomy for MG. Two of these patients were positive for NMo-Ig antibodies in their serum 18 and ANA and anti-GAd were also present in 3 patients, disclosing systemic immune abnormalities. In both series, as in other cases reported before 7,[12][13][14][15] patients developed dd years after undergoing thymectomy, and the authors suggest that thymectomy might have induced immune dysregulation. Indeed, a long-term study of thymectomized patients showed that a significant number of patients presented different autoantibodies in their serum years after thymectomy, 43% developed ANA positivity, 12.5% of them developed autoimmune diseases, and more than 60% had at least 1 expansion within the cd8 and cd4 T-cell repertoire, compared with non-thymectomized patients and healthy control subjects 19 .…”

“…The occurrence of dd in association to MG have been reported before, and are described as monophasic events (myelitis, acute disseminated encephalomyelitis and optic neuritis) [10][11][12][13] and recurrent diseases (multiple sclerosis, recurrent transverse myelitis and NMo) 7,[9][10][11][12]14 . some authors state that this association may not happen by chance, as the incidence of dd in patients with MG is much higher than expected in the general population 6,15 , and both may be part of multiple autoimmune syndromes or genetic predisposition to autoimmunity 5 .…”

“…rarely, MG can be part of multiple autoimmune syndromes, including autoimmune diabetes mellitus, thrombotic thrombocytopenic purpura, sjögren syndrome, systemic lupus erythematosus, vitiligo, among other rare diseases 5 . In the past 20 years there has been an increasing number of reports on patients with MG presenting demyelinating diseases (dd) [6][7][8][9][10][11][12][13][14][15] , including multiple sclerosis, neuromyelitis optica (NMo), transverse myelitis and optic neuritis. however, it is not known whether this association is also part of unspecific immune activation, genetic susceptibility or if it just happens by random.…”

Adult celiac disease with acetylcholine receptor antibody positive myasthenia gravis

“…Celiac disease will have to be added to the increasing list of other autoimmune disorders that have been associated with myasthenia gravis, including diabetes mellitus, rheumatoid arthritis, thyroid disease, neuromyelitis optica (post-thymectomy myasthenia gravis) [21] and multiple sclerosis [22] . The suspicion of a common mechanism between these diseases is well supported by common HLA haplotypes, co-occurrence in the same families and confirmed by their occurrence in the same patients.…”

Myasthenia Gravis Presenting Initially as Acute Respiratory Failure

“…1 The reported prevalence of MG (5-20/100,000 individuals) has been continually increasing. [2][3][4][5] The clinical courses of patients with MG are quite diverse, from complete remission to MGrelated death. 6 MG crisis, defined as an exacerbation of MG requiring ventilatory assistance, is a potentially fatal complication of MG. 7 MG crisis occurs in ϳ20% of patients with MG and usually during the first 2 y of illness.…”