Myasthenia Gravis Associated with a Pelvic Follicular Lymphoma

Overview

Journal BMJ Case Rep

Specialty General Medicine

Date 2022 Jan 14

PMID 35027392

Authors

Charlotte Willis

Max Williamson

Nicholas Constantinou

Emily Johns

Affiliations

Soon will be listed here.

Abstract

An 81-year-old woman presented with neck weakness, dysarthria, dysphasia and left-sided ptosis. Myasthenia gravis (MG) was strongly suspected. Voltage gated calcium channel (VGCC) antibodies, associated with Lambert-Eaton myasthenic syndrome (LEMS), were negative. Acetylcholine receptor (AChR) antibody level was 536 nmol/L and diagnosis of MG was confirmed. Imaging revealed a pelvic mass and subsequent biopsy confirmed a pelvic follicular lymphoma. Our searches revealed this to be the first documented case of MG associated with a pelvic follicular lymphoma. She underwent radiotherapy to treat the lymphoma and received both pyridostigmine and immunosuppression to treat the MG. Her AChR antibody level decreased to 38 nmol/L and her MG symptoms resolved aside from head drop which is continuing to improve. Her lymphoma is now in remission. We have presented a case with a successful outcome, which highlights the importance of screening for lymphoma and thymoma in new presentations of MG.

References

Rezania K, Soliven B, Baron J, Lin H, Penumalli V, Van Besien K . Myasthenia gravis, an autoimmune manifestation of lymphoma and lymphoproliferative disorders: case reports and review of literature. Leuk Lymphoma. 2011; 53(3):371-80. DOI: 10.3109/10428194.2011.615426. View

Davis S, Schumacher M . Myasthenia gravis and lymphoma. A clinical and immunological association. JAMA. 1979; 242(19):2096-7. View

Vernino S, Lennon V . Autoantibody profiles and neurological correlations of thymoma. Clin Cancer Res. 2004; 10(21):7270-5. DOI: 10.1158/1078-0432.CCR-04-0735. View

Iorio R, Damato V, Alboini P, Evoli A . Efficacy and safety of rituximab for myasthenia gravis: a systematic review and meta-analysis. J Neurol. 2014; 262(5):1115-9. DOI: 10.1007/s00415-014-7532-3. View

Manckoundia P, Martin-Pfitzenmeyer I, Pfitzenmeyer P . Myasthenia gravis associated with a B-cell, non-Hodgkin's lymphoma. Eur J Intern Med. 2006; 17(2):146. DOI: 10.1016/j.ejim.2005.10.007. View

Takagi K, Yoshida A, Iwasaki H, Inoue H, Ueda T . Anti-CD20 antibody (Rituximab) therapy in a myasthenia gravis patient with follicular lymphoma. Ann Hematol. 2005; 84(8):548-50. DOI: 10.1007/s00277-005-1050-4. View

Castleman B . The pathology of the thymus gland in myasthenia gravis. Ann N Y Acad Sci. 1966; 135(1):496-505. DOI: 10.1111/j.1749-6632.1966.tb45497.x. View

Nanni L, Broccoli A, Nanni C, Argnani L, Cavo M, Zinzani P . Hodgkin lymphoma presenting with paraneoplastic myasthenia: a case report. Leuk Lymphoma. 2018; 59(12):2990-2993. DOI: 10.1080/10428194.2018.1443336. View

Howard Jr J . Myasthenia gravis: the role of complement at the neuromuscular junction. Ann N Y Acad Sci. 2017; 1412(1):113-128. DOI: 10.1111/nyas.13522. View

10.

Jayam Trouth A, Dabi A, Solieman N, Kurukumbi M, Kalyanam J . Myasthenia gravis: a review. Autoimmune Dis. 2012; 2012:874680. PMC: 3501798. DOI: 10.1155/2012/874680. View

11.

Gajra A, Vajpayee N, Grethlein S . Response of myasthenia gravis to rituximab in a patient with non-Hodgkin lymphoma. Am J Hematol. 2004; 77(2):196-7. DOI: 10.1002/ajh.20169. View