A case of myasthenia gravis accompanied with hasimato thyroiditis and familial mediterranean fever

Familial mediterranean fever (FMF), Hasimato’s thyroiditis (HT) ve Myastenia gravis (MG) are chronical diseases that show autoimmunity. Literature reviews indicate several cases of coexisting MG and HT and only one case coexistence of MG and FMF. We present a clinical table of a 21-year-old male patient with all three diseases. The patient admitted to the hospital with limited eye movements, difficulty in swallowing which became evident towards the end of a meal. The patient had a history of FMF. The anti-TPO and anti-TG levels of the patient had increased. The ACh Receptor antibody was in the normal range (0.01), and the anti-MuSK value was high (>12). Single f iber EMG results of the patient were compatible with myasthenia gravis. The methylprednisolone and pyridostigmine treatment led to an almost complete improvement of the symptoms. As the patient had three different autoimmune disorders at once, it was thought to be a notable case worth presenting.

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Verschuuren J, Palace J, Gilhus NE. Clinical aspects of myasthenia explained. Autoimmunity. 2010;43:344-352).

Kiss MH, Magalhaes CS. Autoinflammatory diseases: mimics of autoimmunity or part of its spectrum? Case presentation. J Clin Immunol. 2008;28:84-9.

Stassi G, DeMaria R. Autoimmune thyroid disease: new models of cell death in autoimmunity. Nat Rev Immunol. 2002;2:195-204.

Christensen PB, Jensen TS, Tsiropoulos I, et al. Associated autoimmune diseases in Myasthenia gravis. A population-based study. Acta Neurologica Scandinavica. 1995;91:192-5.

Evoli A, Padua L. Diagnosis and therapy of Myasthenia gravis with antibodies to muscle-spesific kinase. Autoimmun Rev. 2013:12:931-5.

Granel B, Seratrice J, Dode C, et al. Overlap syndrome between FMF and TRAPS in patient carrying MEFV and TNFRSF1A mutations. Clin Exp Rheumatol. 2007;25:45:93-5.

Karanikas G, Schuetz M, Wahl K, et al. Relation of anti-TPO autoantibody titre and T-lymphocyte cytokine production patterns in hashimoto’s thyroiditis. Clin Endocrinol. 2005;63:191-6.

Ohno M, Hamada N, Yamakawa J et al. Myasthenia gravis associated Graves’ disease in japan. Jpn J Med. 1987;26;2-6.

Simpson JA . Scot Med. 1960;7:419.

Singer W, Sahay BM. Myasthenia gravis, hashimoto’s thyroiditis and pernicious anaemia. Brit Med. 1966;1:904.

Kanawaza M, Shimohata T, Tanaka K, et al. Clinical features of patients with Myasthenia gravis associated with autoimmune diseases. Eur J Neurol. 2007;14:1403-4.

Kubiszewska J, Szyluk B, Szczudlik P, Bartoszewick Z et al. Prevalence and impact of autoimmune thyroid disease on Myasthenia gravis course. Brain Behavior. 2016;6:e00537.

Nakata R, Motomura M, Masuda T et al. Thymus histology and concomitant autoimmune diseases in Japanese patients with muscle-specific receptor tyrosine-antibody-positive Myasthenia gravis. Eur J Neurol. 2013;20:1272-6.

Toth C, McDonald D, Oger J, et al. Acetylcholine receptor antibodies in Myasthenia gravis are associated with greater risk of diabetes and thyroid disease. Acta Neurol Scandinavica. 2006;114:124-32.

Koge J, Hayashi S, Murai H et al. Morvan’s syndrome and Myasthenia gravis related to familial Mediterranean fever gene mutations. J Neuroinflmamation. 2016;13:68.