Abuzneid Yousef S, Yaghi Yasmine, Madia Arein, Salhab Nataly, Amro Naser, Abukhalaf Sadi A, Kharraz Mohammad
Al-Quds University Faculty of Medicine, Jerusalem, Palestine.
An-Najah National University Hospital, Nablus, Palestine.
Ann Med Surg (Lond). 2021 Jul 16;68:102575. doi: 10.1016/j.amsu.2021.102575. eCollection 2021 Aug.
Myasthenia gravis is an organ specific autoimmune disorder that is potentially serious but treatable. It is characterized by fatigability of the voluntary muscles and weakness caused by antibodies against the nicotinic acetylcholine receptor (AChR) on the postsynaptic membrane at the neuromuscular junction.Sometimes, and in very rare cases, it can be associated with other autoimmune conditions in a so called autoimmune polyglandular syndrome type 2, which consists mainly of autoimmune adrenal insufficiency (Addison's disease) with autoimmune thyroid disease and/or type 1 diabetes mellitus.
We describe a case of a 47-year-old male patient presenting with weakness, difficulty swallowing (mainly liquids) and dysarthria. He was discovered to have low cortisol and TSH levels with high T4 and T3. These findings lead to the suspicion of a more complex disease process and through a thorough research of literature we discovered an association between myasthenia gravis and autoimmune polyglandular syndrome specifically type 2 which fits with our patients' presentation.
In any autoimmune disease, it is important to keep in mind associations and susceptibilities to other autoimmune processes and syndromes in order to reach a correct diagnosis and treatment preventing life threating events.
重症肌无力是一种器官特异性自身免疫性疾病，可能很严重但可治疗。其特征是随意肌疲劳以及由针对神经肌肉接头处突触后膜上烟碱型乙酰胆碱受体（AChR）的抗体引起的肌无力。有时，在非常罕见的情况下，它可能与所谓的2型自身免疫性多腺体综合征中的其他自身免疫性疾病相关，该综合征主要由自身免疫性肾上腺功能不全（艾迪生病）伴自身免疫性甲状腺疾病和/或1型糖尿病组成。
我们描述了一名47岁男性患者的病例，该患者表现为肌无力、吞咽困难（主要是液体）和构音障碍。他被发现皮质醇和促甲状腺激素水平低，而T4和T3水平高。这些发现引发了对更复杂疾病过程的怀疑，通过对文献的深入研究，我们发现重症肌无力与特别是2型自身免疫性多腺体综合征之间存在关联，这与我们患者的表现相符。
在任何自身免疫性疾病中，重要的是要牢记与其他自身免疫过程和综合征的关联及易感性，以便做出正确的诊断和治疗，预防危及生命的事件。
