Short communicationThe co-occurrence of serologically proven myasthenia gravis and Miller Fisher/Guillain Barré overlap syndrome — A case report
Introduction
Myasthenia gravis (MG) and the Guillain Barré syndrome (GBS) are well described autoimmune disorders affecting the neuromuscular junction and peripheral nerve respectively which are now recognized to be heterogeneous with autoantibodies against several different antigens [1], [2], [3], [4], [5], [6]. The co-occurrence of MG and GBS is rare. To date there has been only a few cases in the literature [7], [8], [9], [10], [11], [12]. The association of MG and the Miller Fisher syndrome, a variant of GBS, is even rarer, with one case reported [13]. Interestingly, both have remarkably similar clinical features at presentation and neuromuscular transmission abnormalities have been recognized in Miller Fisher syndrome [14], [15], [16], [17].
We report an elderly woman, known to have MG, presenting acutely with ophthalmoplegia and diplopia, bulbar, limb and respiratory muscle weakness, proving to be an acute Miller Fisher/GBS overlap syndrome.
Section snippets
Case report
An 84 year old Chinese lady diagnosed to have ocular myasthenia gravis six years ago and was on pyridostigmine. Five days prior to admission, she developed upper respiratory tract infection followed by ptosis, diplopia, swallowing difficulty and slurring of speech. Her symptoms rapidly deteriorated, with severe weakness of all four limbs and respiratory distress. She was admitted into Intensive Care Unit (ICU) for mechanical ventilation. While on ventilator, she remained conscious and alert.
Discussion
The history and clinical presentation suggested an exacerbation of myasthenia gravis. This diagnosis of MG was supported by repetitive nerve stimulation tests which showed significant decremental response and positive ACh-R antibody. The diagnosis of MG was further confirmed with three Ach-R autoantibodies; namely the ACh-R modulating, binding and blocking autoantibodies.
However, the edrophonium tests performed was negative. Furthermore the NCT had evidence for acute demyelinating peripheral
References (19)
Guillain–Barre syndrome
Lancet
(1998)- et al.
Acute motor sensory Guillain–Barre syndrome and myasthenia gravis
Eur J Intern Med
(2005) - et al.
Serum factor in Miller–Fisher variant of Guillain–Barré syndrome and neurotransmitter release
Lancet
(Feb 19 1994) - et al.
Myasthenia gravis: clinical, immunological and therapeutic advances
Acta Neurol Scand
(2005) - et al.
Acetylcholine receptor antibody as a diagnostic test for myasthenia gravis: result in 153 validated cases and 2967 diagnostic assays
J Neurol Neurosurg Psychiatry
(1985) - et al.
Anti-GQIb IgG-negative case of overlapping Fisher's and Guillain–Barre syndrome after Campylobacter jejuni (PEN 19) enteritis
Clin Neurol
(2001) - et al.
Structure of Campylobacter jejuni lipopolysaccharides determines anti-ganglioside specificity and clinical features Guillain–Barre and Miller Fisher patients
Infect Immun
(2002) - et al.
Anti-GQ1b IgG antibody syndrome: clinical and immunological range
J Neurol Neurosurg Psychiatry
(2001) - et al.
Polyradiculoneuritis and myasthenia gravis
Nouv Presse Med
(1981)
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