Sawada Jun, Asanome Asuka, Endo Hisako, Saito Tsukasa, Katayama Takayuki, Hasebe Naoyuki
Division of Neurology, Department of Internal Medicine, Asahikawa Medical University.
Rinsho Shinkeigaku. 2013;53(5):351-5. doi: 10.5692/clinicalneurol.53.351.
We report an elderly woman with sarcoidosis and rheumatoid arthritis who subsequently developed myasthenia gravis. She was given a diagnose of rheumatoid arthritis at the age of 65 years and sarcoidosis, proved by multiple lymphadenopathy with noncaseating granuloma at the age of 67. Prednisolone, methotrexate, and etanercept had been administrated for rheumatoid arthritis. She consulted our hospital because of bilateral ptosis with diurnal fluctuation at the age of 72. Myasthenia gravis was confirmed by an elevated serum anti-acetylcholine receptor antibody titer (1,100 nmol/l, normal <0.2) and a positive edrophonium test. A chest CT showed a small granular structure in the anterior mediastinum, suggesting thymic hyperplasia. This is the first reported case of myasthenia gravis complicated by sarcoidosis and rheumatoid arthritis. Administration of etanercept may be involved in the onset of myasthenia gravis.
我们报告了一位患有结节病和类风湿关节炎的老年女性，随后她患上了重症肌无力。她在65岁时被诊断为类风湿关节炎，67岁时经多处淋巴结肿大伴非干酪样肉芽肿证实患有结节病。曾使用泼尼松龙、甲氨蝶呤和依那西普治疗类风湿关节炎。她在72岁时因双侧眼睑下垂且有日间波动前来我院就诊。血清抗乙酰胆碱受体抗体滴度升高（1100 nmol/l，正常<0.2）及依酚氯铵试验阳性确诊为重症肌无力。胸部CT显示前纵隔有小颗粒状结构，提示胸腺增生。这是首例报告的结节病和类风湿关节炎并发重症肌无力的病例。依那西普的使用可能与重症肌无力的发病有关。
