Muscle weakness in a girl with autoimmune hepatitis and Graves’ disease

Abstract

Autoimmune hepatitis (AIH) is a chronic hepatic autoimmune disease of unknown etiology associated with inflammatory changes and autoantibodies. The combination of AIH, Grave's disease, and myasthenia gravis (MG) is rare, with only one other case reported. We report a pediatric patient with AIH type 2 and Grave's disease who developed MG whilst on a treatment with corticosteroids. A 13-year-old girl, diagnosed with thyrotoxicosis, was identified as having AIH type 2. During the course of her therapy, she developed muscle weakness. Investigations revealed increased anti-acetylcholine receptor (AChR) antibodies and her electromyography (EMG) was characteristic for MG. Her course is described here. This case highlights the importance of investigating muscle weakness in severely ill hospitalized patients.

Acute presentation of autoimmune hepatitis in a patient with myasthenia gravis, thymoma, Hashimoto thyroiditis and connective tissue disorder

“…The distinguishing feature of this case is acute onset of AIH concurrent with MG and systemic autoimmune disorders even after 2 years following thymectomy. Acute presentation of AIH was also described by Sarkhy et al 15 . in a previously healthy 13‐year‐old girl without thymoma, nevertheless clinical manifestations of MG become apparent in the first days of corticosteroid treatment.…”

“…14 The distinguishing feature of this case is acute onset of AIH concurrent with MG and systemic autoimmune disorders even after 2 years following thymectomy. Acute presentation of AIH was also described by Sarkhy et al 15 in a previously healthy 13-year-old girl without thymoma, nevertheless clinical manifestations of MG become apparent in the first days of corticosteroid treatment. To date, in prior cases reported by Asakawa et al 16 the patient refused thymectomy, by Ko et al 17 thymectomy was performed after resolution of AIH, and by van de Warrenburg et al 18 thymoma was not detected.…”

Prevalence and impact of autoimmune thyroid disease on myasthenia gravis course

“…One‐tailed binomial test was used to compare observed diagnoses frequencies with expected values based on epidemiological data. Distributions of symptoms were compared using chi‐square or Fisher's test (depending on the expected counts Sarkhy et al., ). Ordinal variables (MGFA scores) were compared using Kruskal–Wallis test.…”

“…Hormonal disequilibrium (both hyper‐ and hypothyroidism) as a cause of MG exacerbation was a subject of numerous case reports (Konno et al., ; Sarkhy, Persad, & Tarnopolsky, ). There is little data on the impact of ATD on the long‐term course of MG.…”

Thyrotoxic hepatitis

“…объясняет случаи сочетания болезни Грейвса с аутоиммунным гепатитом [4,5,8] и первичным билиарным циррозом [6].…”