Department of Neurology, Chosun University College of Medicine, Gwangju, South Korea.
Department of Neurology, Jeonbuk National University Medical School and Hospital, Jeonju, South Korea.
Medicine (Baltimore). 2022 Feb 25;101(8):e28887. doi: 10.1097/MD.0000000000028887.
Patients with myasthenia gravis may also have comorbid autoimmune diseases. Since both myasthenia gravis and neuromyelitis optica spectrum disease are mediated by antibodies, they are likely to occur together. However, since multiple sclerosis is an autoimmune disease that is not mediated by a specific antibody, it has fewer immune mechanisms in common with myasthenia gravis than neuromyelitis optica spectrum disease. We encountered a case of newly developed multiple sclerosis in a patient with myasthenia gravis.
A 46-year-old man was diagnosed with ocular myasthenia gravis 6 years ago and had been taking pyridostigmine to control his symptoms.
The patient developed right optic neuritis, and multiple sclerosis was suspected based on the brain magnetic resonance imaging findings. However, the required diagnostic criteria were not met.
Disease-modifying therapy was not initiated, and clinical progression of the disease was monitored.
One year after the onset of optic neuritis, the patient developed myelitis and was diagnosed with multiple sclerosis, prompting treatment with disease-modifying therapy.
When optic neuritis occurs in patients with myasthenia gravis, careful evaluation is necessary while considering the possibility that it may be the first symptom of a demyelinating central nervous system disease. Therefore, it is important to conduct shorter-interval monitoring and symptom screening for patients with neurological autoimmune diseases, such as myasthenia gravis, even if multiple sclerosis is not initially suspected, to achieve early detection of multiple sclerosis.
重症肌无力患者可能同时患有合并自身免疫性疾病。由于重症肌无力和视神经脊髓炎谱系疾病都是由抗体介导的，因此它们很可能同时发生。然而，多发性硬化症是一种自身免疫性疾病，不是由特定抗体介导的，因此与视神经脊髓炎谱系疾病相比，与重症肌无力的免疫机制共同点较少。我们遇到了一例重症肌无力患者新发多发性硬化症的病例。
一名 46 岁男性 6 年前被诊断为眼肌型重症肌无力，一直服用吡啶斯的明来控制症状。
患者出现右眼视神经炎，根据脑部磁共振成像结果怀疑多发性硬化症，但未达到所需的诊断标准。
未启动疾病修正治疗，仅对疾病进展进行了监测。
视神经炎发病 1 年后，患者出现脊髓炎，被诊断为多发性硬化症，从而开始进行疾病修正治疗。
当重症肌无力患者出现视神经炎时，需要仔细评估，同时要考虑到这可能是脱髓鞘中枢神经系统疾病的首发症状。因此，对于重症肌无力等神经自身免疫性疾病患者，即使最初不怀疑多发性硬化症，也需要进行更短间隔的监测和症状筛查，以实现多发性硬化症的早期发现。
