Karan Yagnik Payal Chhabria Hardikkumar Bhanderi Peter N. Fish

Abstract

Multiple autoimmune syndrome (MAS) is characterized by the coexistence of three or more autoimmune diseases. We are reporting a unique case of MAS, presented as a Myasthenia Gravis exacerbation, found to have unexpected sero-abnormalities. A 39-year-old female presented with complaints of progressive difficulty swallowing of solids and liquids, droopy eyelids, and facial weakness. Physical examination revealed bilateral ptosis and proptosis, slow-muffled speech, loss of EOM, inability to smile, puff cheeks, clench teeth, or protrude tongue and an asymmetrical shoulder shrug. Motor tone was normal except ⅘ in the left arm and ⅗ in left hand with loss of flexion at left DIP joints. Acetylcholine receptor binding antibodies, ANA, Antithyroid peroxidase, antithyroglobulin and Anti SS-A were positive. MAS, while not a life-threatening condition, greatly degrades patients’ quality of life. We recommend that when you encounter patients with one or more autoimmune disorder, you consider MAS in your differential.

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Keywords

Multiple autoimmune syndrome, Thyroiditis, myastenia gravis

References
1. Cooper GS, Stroehla BC. The epidemiology of autoimmune diseases. Autoimmun Rev. 2003 May;2(3):119-25. doi: 10.1016/s1568-9972(03)00006-5. PMID: 12848952.
2. Humbert P, Dupond JL. Les syndromes auto-immuns multiples (S.A.M.) [Multiple autoimmune syndromes]. Ann Med Interne (Paris). 1988;139(3):159-68. French. PMID: 3059902.
3. Mohan MP, Ramesh TC. Multiple autoimmune syndrome. Indian J Dermatol Venereol Leprol. 2003 Jul-Aug;69(4):298-9. PMID: 17642919.
4. Sloka S. Observations on recent studies showing increased co-occurrence of autoimmune diseases. J Autoimmun. 2002 May;18(3):251-7. doi: 10.1006/jaut.2002.0588. PMID: 12126638.
5. Wielosz E, Majdan M, Zychowska I, Jeleniewicz R. Coexistence of five autoimmune diseases: diagnostic and therapeutic difficulties. Rheumatol Int. 2008 Jul;28(9):919-23. doi: 10.1007/s00296-008-0544-5. PMID: 18320193.
6. Tanovska N, Novotni G, Sazdova-Burneska S, et al. Myasthenia Gravis and Associated Diseases. Open Access Maced J Med Sci. 2018 Mar 5;6(3):472-478. doi: 10.3889/oamjms.2018.110. PMID: 29610603; PMCID: PMC5874368.
7. Mao ZF, Yang LX, Mo XA, et al. Frequency of autoimmune diseases in myasthenia gravis: a systematic review. Int J Neurosci. 2011 Mar;121(3):121-9. doi: 10.3109/00207454.2010.539307. PMID: 21142828.
8. Marinó M, Ricciardi R, Pinchera A, et al. Mild clinical expression of myasthenia gravis associated with autoimmune thyroid diseases. J Clin Endocrinol Metab. 1997 Feb;82(2):438-43. doi: 10.1210/jcem.82.2.3749. PMID: 9024233.
9. Chen YL, Yeh JH, Chiu HC. Clinical features of myasthenia gravis patients with autoimmune thyroid disease in Taiwan. Acta Neurol Scand. 2013 Mar;127(3):170-4. doi: 10.1111/j.1600-0404.2012.01693.x. PMID: 22725712.
10. Gilhus NE, Nacu A, Andersen JB, Owe JF. Myasthenia gravis and risks for comorbidity. Eur J Neurol. 2015 Jan;22(1):17-23. doi: 10.1111/ene.12599. PMID: 25354676.
11. Thorlacius S, Aarli JA, Riise T, Matre R, Johnsen HJ. Associated disorders in myasthenia gravis: autoimmune diseases and their relation to thymectomy. Acta Neurol Scand. 1989 Oct;80(4):290-5. doi: 10.1111/j.1600-0404.1989.tb03881.x. PMID: 2816285.
12. Theander E, Jacobsson LT. Relationship of Sjögren's syndrome to other connective tissue and autoimmune disorders. Rheum Dis Clin North Am. 2008 Nov;34(4):935-47, viii-ix. doi: 10.1016/j.rdc.2008.08.009. PMID: 18984413.
13. Evoli A, Batocchi AP, Tonali P, Marciano M. Risk of cancer in patients with myasthenia gravis. Ann N Y Acad Sci. 1998 May 13;841:742-5. doi: 10.1111/j.1749-6632.1998.tb11011.x. PMID: 9668323.
14. Monden Y, Uyama T, Kimura S, Taniki T. Extrathymic malignancy in patients with myasthenia gravis. Eur J Cancer. 1991;27(6):745-7. doi: 10.1016/0277-5379(91)90179-h. PMID: 1829916.
15. Pan CC, Chen PC, Wang LS, Chi KH, Chiang H. Thymoma is associated with an increased risk of second malignancy. Cancer. 2001 Nov 1;92(9):2406-11. doi: 10.1002/1097-0142(20011101)92:9<2406::aid-cncr1589>3.0.co;2-7. PMID: 11745297.
16. Wakata N, Sugimoto H, Nomoto N, et al. Extrathymic tumors in patients with myasthenia gravis: a 35-year retrospective study. Neurologist. 2006 Jan;12(1):53-5. doi: 10.1097/01.nrl.0000195828.36108.c3. PMID: 16547448.
17. Gale J, Danesh-Meyer HV. Statins can induce myasthenia gravis. J Clin Neurosci. 2014 Feb;21(2):195-7. doi: 10.1016/j.jocn.2013.11.009. PMID: 24433954.
18. Cojocaru M, Cojocaru IM, Silosi I. Multiple autoimmune syndrome. Maedica (Bucur). 2010 Apr;5(2):132-4. PMID: 21977137; PMCID: PMC3150011.
How to Cite
Yagnik, K., Chhabria, P. ., Bhanderi, H. ., & Fish, P. N. . (2024). Unveiling the uncommon: a captivating case of multiple autoimmune syndrome. Archive of Clinical Cases, 11(3), 83-85. https://doi.org/10.22551/2024.44.1103.10293
Section
Case Reports

How to Cite

Yagnik, K., Chhabria, P. ., Bhanderi, H. ., & Fish, P. N. . (2024). Unveiling the uncommon: a captivating case of multiple autoimmune syndrome. Archive of Clinical Cases, 11(3), 83-85. https://doi.org/10.22551/2024.44.1103.10293