Minimal change disease in a patient with myasthenia gravis

Abstract

Background:Myasthenia gravis superimposed with proteinuria is a very rare disorder with only 39 cases reported so far. Of these cases, the most commonly associated disorder is minimal change disease. Myasthenia gravis and minimal change disease are both related to the dysfunction of T lymphocytes and hence the 2 disorders may be connected.Methods:Here we report the first case on a patient diagnosed with myasthenia gravis concurrently with the minimal change disease, and it was presented in the absence of thymoma or thymic hyperplasia.Results:Treatment for myasthenia gravis also lowered proteinuria of minimal change disease. He ever experienced good control for myasthenia gravis and minimal change disease. However, pneumonia related septic shock occurred to him and finally he was dead. Minimal change disease is generally considered to occur subsequent to the onset of myasthenia gravis with causal association. After extensive literature review, we noted only 47.8% minimal change disease had occurred after the onset of myasthenia gravis.Conclusion:Minimal change disease mostly occurs in children and if diagnosed in adults, clinicians should search for a potential cause such as myasthenia gravis and other associated thymic disorders.

Secondary membranous nephropathy in a patient with myasthenia gravis without thymic disease, and partial remission induced by adrenocorticotropic hormone therapy

“…MG is rarely associated with nephropathy. 12 In some cases of nephrotic syndrome, the mechanism is an imbalance between T helper cells class 1 and 2. 13 In MG, T cell dysfunction leads to the production of lymphokine, which increases the permeability of GBM.…”

“…The benefit of therapy using steroids and immunosuppressants suggests that membranous nephropathy is related to the disordered immune system. 12 Thymectomy, which is a standard therapy for MG, is still considered as an option for treatment. Thymectomy can be followed by numerous changes in lymphocyte functions which may require several years to be revealed, 24 suggesting that careful long-term follow-up for is necessary.…”