Myasthenia gravis developing in a patient with CNS lymphoma

Abstract

A patient was initially diagnosed with right basal ganglia lymphoma causing left hemiparesis. His disease was resistant to intravenous methotrexate, so he received radiation therapy with remarkable regression of the mass. However, 6 months after his initial diagnosis, he developed symmetric weakness of the proximal muscles. Electromyography was consistent with myasthenia gravis and anti-acetylcholine receptor antibodies were elevated. Treatment with pyridostigmine and corticosteroids improved his symptoms. The residual lymphoma was further treated with rituximab and temozolomide with complete resolution. Pyridostigmine and corticosteroids were stopped after 14 months of initiation with good results. Our case is the first case report of paraneoplastic myasthenia gravis developing in a patient with primary CNS lymphoma. The diagnosis of paraneoplastic myasthenia should be considered in patients with CNS lymphoma who develop muscle weakness and speech problems.

Rituximab treatment of myasthenia gravis: A systematic review

“…A total of 47 publications were reviewed, of which 28 were single case reports and 19 reporting 2 or more patients (range 2–22) . Only data available on unique cases from all published reports were included; data from publications that reported cases presented in earlier reports were excluded.…”

Myasthenia gravis in dogs with an emphasis on treatment and critical care management

“…A paraneoplastic form of MG can occur with thymomas as well as others neoplasms. There have been case reports of acquired MG in dogs with cholangiocellular carcinoma and CNS lymphoma 34,35 . In people, 30–60% of thymomas are associated with MG 2 .…”

“…There have been case reports of acquired MG in dogs with cholangiocellular carcinoma and CNS lymphoma. 34,35 In people, 30-60% of thymomas are associated with MG. 2 In dogs that have thymomas, 30-50% have been identified to have MG. 36 The association between the presence of thymoma and MG is well characterized. [36][37][38][39]…”

Focal form of acquired myasthenia gravis with megaesophagus in a Yorkshire terrier dog

“…Additionally, paraneoplastic forms of MG have been reported with cholangiocellular carcinomas and CNS lymphomas as well as thymomas [8,12].…”