Myasthenia Gravis and Stroke in the Setting of Giant Cell Arteritis

Abstract

This case report concerns the diagnosis of two independent chronic diseases in a patient hospitalized for stroke, myasthenia gravis (MG) and giant cell arteritis (GCA). MG has been found to be associated with several diseases, but there are very few cases documenting its coexistence with GCA. We report the case of a 79-year-old woman initially hospitalized for stroke. Patient's concurrent symptoms of blepharoptosis, dysphagia, and proximal muscle weakness were strongly suggestive of myasthenia gravis. The persistent low-grade fever and elevated inflammatory markers in combination with the visual deterioration that developed also raised the suspicion of GCA. Histological examination confirmed GCA, while muscle acetylcholine receptor antibodies were also present. Even though in medicine one strives to interpret a patient's symptoms with one diagnosis, when one entity cannot fully interpret the clinical and laboratory findings, clinicians must consider the possibility of a second coexisting illness.

Concomitant Seropositive Ocular Myasthenia and Biopsy-Proven Temporal Arteritis

“…The 2 conditions occurring together is indeed rare. In our review of the literature, a study demonstrated only 1 diagnosis of concomitant OMG among 250 cases of GCA (3), and another well-documented case of confirmed concurrent OMG, and GCA was found (1). It is also important to keep in mind that flexibility in adjusting the working diagnosis is crucial to avoid missing a condition that is mimicked by another, as exemplified in a case where a patient with GCA presented with symptoms similar to OMG (4).…”

“…Arriving at the conclusion of 2 independent, concurrent diagnoses can be easy to miss, especially when the prevalence of each condition is low (1,2). In the case of a patient presenting with direction and amplitude-changing diplopia and ptosis, OMG should be considered; however, with elevated inflammatory markers, GCA cannot be ignored.…”

“…The rare co-occurrence of OMG and GCA may be attributed to immune system dysfunction that is associated with OMG, leading to other autoimmune disorders (1). When the 2 conditions present concurrently, further workup and management are greatly affected.…”