Systemic lupus erythematosus-myasthenia gravis overlap syndrome: Presentation and treatment depend on prior thymectomy

Abstract

In this study, we investigated four patients who met the diagnostic criteria for overlapping systemic lupus erythematosus (SLE) and myasthenia gravis (MG) but responded differently to treatment. All patients were acetylcholine receptor (AChR) and antinuclear antibody positive at the time of SLE diagnosis. Two patients presented with SLE who have been effectively treated with cholinesterase inhibitors for MG. These patients developed SLE with photosensitivity, rash, and arthritis post thymectomy, which had been performed 29 years and 40 years earlier, respectively. Two other patients were found to have AChR antibodies and MG in the context on new-onset SLE. These subjects were responsive to hydroxychloroquine and immunosuppression but failed cholinesterase inhibitors. The evolution of these cases is relevant for the role of thymus in lupus pathogenesis during aging and for treatment selection in SLE-MG overlap patients.

Ischaemic stroke in a patient with myasthaenic crisis and antiphospholipid antibody syndrome

“…Of these, only our case received thrombolysis with rTPA. Similar to large studies on polyautoimmunity,24 female predominance is also seen in our review with only one male patient having APAS and MG 14. SLE was also found in three of the patients 14 25.…”

“…Similar to large studies on polyautoimmunity,24 female predominance is also seen in our review with only one male patient having APAS and MG 14. SLE was also found in three of the patients 14 25. A systematic review found that patients with MG who are seropositive are 3.68 times more likely to develop other autoimmune disease compared with those who are seronegative 22.…”

“…Predictors for these comorbid autoimmune conditions, seropositivity to MG autoantibodies and the female sex are both found in our patient 22. While the relationship of SLE with both MG and APAS has been established in several series,14 23 concurrent MG and APAS is much more uncommon.…”

“…After a thorough search of literature, we enumerate the rare instances when MG and APAS have been reported in the same patient (see table 1). Including our case, five cases of stroke associated with MG and APAS have been documented 9 11 12 14. Of these, only our case received thrombolysis with rTPA.…”

“…The diagnosis of APAS requires one clinical event and serological evidence of autoimmunity 7. Although the asymptomatic occurrence of antiphospholipid antibodies in patients with MG has been well documented8; thus far, there have only been eight reported cases of the co-occurrence of MG and APAS 9–14. This report follows the ninth case of MG and APAS co-occurrence and presents a treatment strategy for ischaemic stroke in a patient with myasthaenic crisis, a condition that has not yet been described in literature.…”