A case of thymoma-associated myasthenia gravis accompanied with myositis showing the clusters of histiocyte along the fascicles in perimysium

Patients with myasthenia gravis (MG) often have other autoimmune disorders. However, the coexistence of MG and myositis is rare. Here, we report a case of a 77-year-old woman who developed mild fatigable muscle weakness and diplopia in 3 months. Serum creatine kinase was elevated to 1385 IU/L. Antib...

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Bibliographic Details
Published in:Clinical neurology and neurosurgery 2023-06, Vol.229, p.107715, Article 107715
Main Authors: Terayama, Atsushi, Yoshikawa, Keisuke, Michiura, Toru, Fujii, Kanako, Inada, Rino, Mitsui, Yoshiyuki, Nishino, Ichizo, Nagai, Yoshitaka
Format: Article
Language:English
Subjects:
Acetylcholine receptors
Activities of daily living
Aged
Antibodies
Autoantibodies
Autoimmune diseases
Biopsy
Case reports
Channel gating
Coexistence
Connectin
Creatine
Creatine kinase
Diplopia
Dysphagia
Editing
Electromyography
Female
Histiocyte
Histiocytes
Humans
Inflammatory diseases
Lymphocytes
Magnetic resonance imaging
Motor units
Musculoskeletal diseases
Myasthenia Gravis
Myocarditis
Myositis
Neurology
Neuromuscular junctions
Peptides
Potassium channels (voltage-gated)
Thymoma
Thymoma - complications
Thymus Neoplasms - complications
Thyroid gland
Writing
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Summary:Patients with myasthenia gravis (MG) often have other autoimmune disorders. However, the coexistence of MG and myositis is rare. Here, we report a case of a 77-year-old woman who developed mild fatigable muscle weakness and diplopia in 3 months. Serum creatine kinase was elevated to 1385 IU/L. Antibodies to acetylcholine receptor (AChR), titin and voltage-gated potassium channel 1.4 (Kv 1.4) were all positive while all tested myositis-specific autoantibodies were negative. Standard needle electromyography showed fibrillation potential and early recruitment of motor units. The repetitive nerve stimulations were consistent with a disorder of the neuromuscular junction. Muscle biopsy showed that the clusters of histiocyte were present along the fascicles in perimysium and some of them invaded into endomysium. •Our patient showed thymoma-associated myasthenia gravis (MG) accompanied with myositis.•Muscle biopsy showed unique distribution of histiocytes.•The histiocytes were along the fascicles in perimysium.
ISSN:0303-8467
1872-6968
DOI:10.1016/j.clineuro.2023.107715