The co-existence of myasthenia gravis in patients with myositis: A case series |
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| Affiliation: | 1. Department of Neurology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece;2. Second Department of Neurology, University of Athens, School of Medicine, “Attikon” University Hospital, Athens, Greece;3. International Clinical Research Center, St. Anne''s University Hospital in Brno, Czech Republic;4. Cardiothoracic Department, University Hospital of Alexandroupolis, Alexandroupolis, Greece;5. Department of Neurology, University of Ioannina, School of Medicine, Ioannina, Greece;6. First Department of Neurology, University of Athens, School of Medicine, “Eginition” University Hospital, Athens, Greece;1. Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan;2. Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan;1. Department of Hematology and Rheumatology, Saiseikai Noe Hospital, Osaka, Japan;2. Cancer Center, Hyogo College of Medicine, Hyogo, Japan;3. Department of Respiratory Medicine, Saiseikai Noe Hospital, Osaka, Japan;4. Department of Pathology, Saiseikai Noe Hospital, Osaka, Japan;5. Department of Pathology, Akashi City Hospital, Hyogo, Japan;6. Department of Diagnostic Pathology, Dokkyo Medical University School of Medicine, Tochigi, Japan |
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| Abstract: | ObjectiveMyositis and myasthenia gravis (MG) are both autoimmune disorders presenting with muscle weakness. Rarely, they occur simultaneously in the same patient. Since the management of myasthenia gravis differs from that of myositis, it is important to recognize when patients have both diseases. We reviewed the cases of 6 patients with both myositis and MG to identify clinical features that suggest the possibility of co-existing MG in myositis patients.MethodsWe identified 6 patients with dermatomyositis or polymyositis and MG. We reviewed their medical records to assess their clinical presentations, laboratory findings, and electrophysiological features.ResultsAll 6 patients had definite dermatomyositis or polymyositis by the criteria of Bohan and Peter as well as electrophysiologic and/or serologic confirmation of MG. Among overlap patients, 5/6 (83%) had bulbar weakness, 2/6 (33%) had ptosis, and 1/6 (17%) had diplopia. Fatigable weakness was noted by 5/6 (83%) patients. Treatment with pyridostigmine improved symptoms in 5/6 (83%) patients. High-dose steroids were associated with worsening weakness in 2/6 (33%) patients.ConclusionsProminent bulbar symptoms, ptosis, diplopia, and fatigable weakness should suggest the possibility of MG in patients with myositis. A suspicion of MG may be confirmed through appropriate electrophysiologic and laboratory testing. In those with myositis–MG overlap, high-dose steroids may exacerbate symptoms and pyridostigmine may play an important therapeutic role. |
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| Keywords: | Myositis Dermatomyositis Polymyositis Myasthenia gravis |
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