MIJASTENIJA GRAVIS I HRONIČNA INFLAMATORNA DEMIJELINIZACIONA POLINEUROPATIJA KOD PACIJENATA SA RECIDIVANTNIM TIMOMOM

Vesna V. Martić; Esmer Fejzić; Nebojša Marić

doi:10.5937/smclk4-43219

Vesna V. Martić Vojnomedicinska Akademija
Esmer Fejzić Vojnomedicinska akademija https://orcid.org/0000-0002-5430-6043
Nebojša Marić Vojnomedicinska akademija

DOI: https://doi.org/10.5937/smclk4-43219

Ključne reči: Mijastenija gravis, CIDP, Timom

Sažetak

Mijastenija gravis (MG) i hronična inflamatorna demijelinizaciona polineuropatija (engl. chronic inflammatory demyelinating polyneuropathy – CIDP) su autoimunske bolesti usmerene na različite targete: kod mijastenije gravis, to je postsinaptička membrana skeletne muskulature, dok su kod CIDP-a u pitanju periferni nervi. Za razliku od mijastenije gravis, koju viđamo u značajnom procentu obolelih sa timomom, udruženost CIDP-a sa mijastenijom gravis i timomom je retkost.

Ovo je prikaz bolesnika sa dugogodišnjom anamnezom mijastenije gravis nesigurnog toka, koji je u više navrata operisan od recidiva timoma. Kod bolesnika se, posle dugogodišnje kliničke remisije od 16 godina, a u sklopu ponovne egzacerbacije timoma razvio CIDP, bez znakova mijastenične slabosti.

Biografija autora

Vesna V. Martić, Vojnomedicinska Akademija

Docent, doktor nauka

Klinika za neurologiju

Reference

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.