Rózsa Csilla, Kis Gábor, Komoly Sámuel, Anselmo Viktória, Esik Olga, Láng István, Kas József, Németh György, Solymosi Diana, Svasztics Egon, Szentirmay Zoltán, Szobor Albert, Telekes András
Jahn Ferenc Teaching Hospital, Budapest.
Ideggyogy Sz. 2004 Jul 20;57(7-8):242-4.
A 44-year-old male patient was hospitalised with paranoid schizophrenia in 1985. Depot neuroleptic treatment was started which successfully prevented further psychotic relapses for the next ten years. His myasthenia gravis started with bulbar signs in 1997 and the symptoms soon became generalized. The diagnosis of myasthenia gravis was confirmed by electromyography, by positive anticholinesterase test and by the detection of anti-acetylcholine receptor antibodies in the serum. Mediastinal CT examination showed enlarged hilar lymph nodes on the left but no thymic pathology was observed. Mediastinoscopy was performed and biopsies were obtained from the affected nodes. Histology revealed sarcoidosis. The patient suffered respiratory crisis following the thoracic intervention (in September 1998). Combined oral corticosteroid (64 mg methylprednisolone/e.o.d.) and azathioprine (150 mg/day) treatment regimen was initiated and complete remission took place in both the myasthenic symptoms and the sarcoidosis. The follow-up CT scans showed no mediastinal pathology (January 2000). During steroid treatment a transient psychotic relapse occurred which was successfully managed by supplemental haloperidol medication added to his regular depot neuroleptics. The patient currently takes 150 mg/day azathioprine and receives 40 mg/month flupentixol depot i.m. His physical and mental status are stable and he has been completely symptom free in the last 24 months. The association of myasthenia gravis and sarcoidosis is very rare. To our best knowledge no case has been reported of a patient suffering from myasthenia gravis, sarcoidosis, and schizophrenia at the same time.
一名44岁男性患者于1985年因偏执型精神分裂症住院。开始使用长效抗精神病药物治疗，在接下来的十年中成功预防了进一步的精神病复发。他的重症肌无力于1997年开始出现延髓症状，症状很快蔓延至全身。通过肌电图、阳性抗胆碱酯酶试验以及血清中抗乙酰胆碱受体抗体的检测，确诊为重症肌无力。纵隔CT检查显示左侧肺门淋巴结肿大，但未观察到胸腺病变。进行了纵隔镜检查并从受累淋巴结获取了活检组织。组织学检查显示为结节病。该患者在胸部干预后（1998年9月）出现呼吸危机。开始联合口服皮质类固醇（64毫克甲泼尼龙/隔日）和硫唑嘌呤（150毫克/天）治疗方案，重症肌无力症状和结节病均完全缓解。后续CT扫描显示无纵隔病变（2000年1月）。在类固醇治疗期间发生了一次短暂的精神病复发，通过在其常规长效抗精神病药物中添加补充氟哌啶醇药物成功控制。该患者目前每天服用150毫克硫唑嘌呤，并每月接受40毫克氟哌噻吨长效肌内注射。他的身体和精神状况稳定，在过去24个月中完全没有症状。重症肌无力与结节病的关联非常罕见。据我们所知，尚未有同时患有重症肌无力、结节病和精神分裂症的患者的病例报道。
