MYASTHENIA GRAVIS AND CHRONIC INFLAMMATORY DEMYELINATING POLYNEUROPATHY IN A PATIENT WITH RECURRENT THYMOMA

Keywords: Myasthenia gravis, CIDP, Thymoma

Abstract


Myasthenia gravis (MG) and chronic inflammatory demyelinating polyneuropathy (CIDP) are autoimmune diseases aimed at different targets: in MG, it is the postsynaptic membrane of the skeletal musculature, while in CIDP, it is the peripheral nerves. Unlike MG, which can be observed in a significant percentage of patients with thymoma, the association of CIDP with MG and thymoma is rare.

This is a report on a patient with a long-term history of myasthenia gravis with an unstable course, who was operated on several times because of the recurrence of thymoma. In the patient, after a long-term clinical remission lasting 16 years, and as part of the re-exacerbation of the thymoma, CIDP developed without signs of myasthenic weakness..

Author Biography

Vesna V. Martić, Vojnomedicinska Akademija

Docent, doktor nauka

Klinika za neurologiju

References

1. Jaretzki A 3rd, Barohn RJ, Ernstoff RM, Kaminski HJ, Keesey JC, Penn AS, et al. Myasthenia gravis: recommendations for clinical research standards. Task Force of the Medical Scientific Advisory Board of the Myasthenia Gravis Foundation of America. Ann Thorac Surg. 2000 Jul;70(1):327-34. doi: 10.1016/s0003-4975(00)01595-2.

2. Levinson AI. Modeling the intrathymic pathogenesis of myasthenia gravis. J Neurol Sci. 2013 Oct 15;333(1-2):60-7. doi: 10.1016/j.jns.2012.12.025.

3. Vesna Martić, Nebojša Marić, Vlado Cvijanović. The neurological outcome in the patients with myasthenia gravis who underwent thymectomy via sternotomy and video-assisted thoracoscopic surgery (VATS). Vojnosanit pregl, 2021; 78 (8): 818-24.

4. Sugarbaker DJ. Thoracoscopy in the management of anterior mediastinal masses. Ann Thorac Surg. 1993 Sep;56(3):653-6. doi: 10.1016/0003-4975(93)90942-b. 

5. Vesna Martić, Nebojša Marić, Dragan Djordjević. Thymectomy immediately after myasthenic crisis - case report. Vojnosanit pregl. 2021; 78 (8): 887-9.

6. Marx A, Chan JK, Coindre JM, Detterbeck F, Girard N, Harris NL, et al. The 2015 World Health Organization Classification of Tumors of the Thymus: Continuity and Changes. J Thorac Oncol. 2015 Oct;10(10):1383-95. doi: 10.1097/JTO.0000000000000654.

7. Blum TG, Misch D, Kollmeier J, Thiel S, Bauer TT. Autoimmune disorders and paraneoplastic syndromes in thymoma. J Thorac Dis. 2020 Dec;12(12):7571-7590. doi: 10.21037/jtd-2019-thym-10.  

8. Kimura K, Nezu A, Kimura S, Otsuki N, Kobayashi T, Nomura Y, et al. A case of myasthenia gravis in childhood associated with chronic inflammatory demyelinating polyradiculoneuropathy. Neuropediatrics. 1998 Apr;29(2):108-12. doi: 10.1055/s-2007-973544.

9. Fleisher J, Richie M, Price R, Scherer S, Dalmau J, Lancaster E. Acquired neuromyotonia heralding recurrent thymoma in myasthenia gravis. JAMA Neurol. 2013 Oct;70(10):1311-4. doi: 10.1001/jamaneurol.2013.2863.

10. Sawhney S, Asranna A, Sureshbabu S, Peter S, Chindripu S, Mittal GK. Malignant thymoma and chronic inflammatory demyelinating neuropathy. Muscle Nerve. 2021 Feb;63(2):E10-E13. doi: 10.1002/mus.27132.

11. Holbro A, Jauch A, Lardinois D, Tzankov A, Dirnhofer S, Hess C. High prevalence of infections and autoimmunity in patients with thymoma. Hum Immunol. 2012 Mar;73(3):287-90. doi: 10.1016/j.humimm.2011.12.022.

Published
2023/06/30
Section
Case reviews