Brief Report
Myasthenia gravis and Guillain-Barré cooccurrence syndrome☆,☆☆,★

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Abstract

Objective

The objective of this study was to review all cases in literature in which the clinical manifestations of myasthenia gravis (MG) and Guillain-Barré syndrome (GBS) were presented in the same patient including a new case of our own and identify the clinical characteristics and possible mechanisms of this syndrome.

Methods

We reviewed 12 reports in which 13 cases were diagnosed as MG and GBS. The clinical manifestations of the 13 cases and our new case were analyzed in detail to show the characteristics of this kind of syndrome.

Results

Of all the cases, 5 females and 9 males, 6 of them were Chinese; 3 were Americans; 3 were Israelis; 1 was white and one was a Frenchman. The age of seven patients was no more than 45 years old. They all had the symptoms of extrocular muscle weakness. Nerve conduction and RNS abnormal were seen in all tested cases. Acetylcholine receptor antibody was positive in all tested patients. Prognosis was good in 8 of the 11 recorded patients.

Conclusions

Although extremely rare, MG and GBS may present in the same patient with variant characteristics. The typical clinical characteristics of GBS and MG may be helpful for the diagnosis of future possible cases.

Introduction

Myasthenia gravis (MG) is a neuromuscular disorder characterized by weakness and fatigability of skeletal muscles. The underlying defect is a decrease in the number of available acetylcholine receptors (AChRs) at neuromuscular junctions due to an antibody-mediated autoimmune attack [1].

Guillain-Barré syndrome (GBS) is an acute, frequently severe, and fulminant polyradiculoneuropathy that is autoimmune in nature. Circumstantial evidence suggests that all GBS results from immune responses to nonself antigens (infectious agents, vaccines) that misdirect to host nerve tissue through a resemblance-of-epitope (molecular mimicry) mechanism [2].

The coexistence of MG and GBS overlap syndrome is really rare. To our best of knowledge, there are only 14 reports in which 15 cases were diagnosed as coexistence of MG and GBS [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16]. We reviewed the reports published in English in detail together with a new case of our own.

Section snippets

Case presentation

An old woman aged 73 years came to our hospital and complained of mild dyspnea together with mild dysarthria and dysphagia for 2 days. One week before these symptoms, she experienced upper respiratory infection. Three days after admission, her breathing suddenly stopped and she got unconscious, so she was intubated immediately. While on ventilator, she remained conscious and alert, but she developed ptosis and weakness of all four limbs gradually after another three days. Neurological

Results

Fourteen reports in which 15 cases were diagnosed as coexistence of MG and GBS were retrieved in PubMed. Two reports were published, one in French and one in Spanish, so their characteristics were not all included in our study. Only part of the clinical features of the French case was included in our study.

The general characteristics of the 13 cases and our new one are reviewed in Table 1 [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15]. Of all the cases, 7 of them were

Discussion

The diagnosis of MG on our case was made based on the typical clinical findings such as bilateral ptosis and diplopia, dysarthria, dysphagia, and respiratory muscle weakness. Decremental response of RNS, positive AChR antibody, and erophonium test were typical of MG. At the same time, she got an infectious disease prior to the onset of the syndrome. Dysarthria, dysphagia, and respiratory muscle weakness may also be the symptoms of the peripheral polyneuropathy. Flaccid tetraparesis and

Acknowledgments

The authors thank this patient for her participation in our study. We also thank our colleague Junling Yuan and Jian Li for their warmhearted help in the submission process of this article.

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Authors' contributions: Juan Zhang examined and evaluated the patient, collected and analyzed the data, and drafted the manuscript. Wenli Hu participated in the design of the brief report and helped draft the manuscript. Shiqin Niu and Yan Wang revised the manuscript. All authors read and approved the final manuscript.

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Consent: Written informed consent was obtained from the patient for publication of this brief report. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

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Conflict of interests: The authors declare that they have no conflict of interests.

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