Unveiling the uncommon: a captivating case of multiple autoimmune syndrome
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.
##plugins.themes.bootstrap3.article.details##
Multiple autoimmune syndrome, Thyroiditis, myastenia gravis
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.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Archive of Clinical Cases is protected by copyright and may be used in accordance with copyright and other applicable laws. Content available at www.clinicalcases.eu and our digital applications is intended for personal noncommercial use.
Authors who submit a manuscript for publication in Archive of Clinical Cases agree to the following terms: a. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal. b. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal. c. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) only after the final version of the manuscript was accepted and published, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access). d. It is compulsory that before submission authors ensure that their work was not published in any other medical journals or pending acceptance for publication and that "Archives of Clinical Cases" is the only beneficiary at that moment if their work/case will be accepted by us.
Guidelines for linking to www.clinicalcases.eu a. The main purpose of the site linking to the Archive of Clinical Casess site should be educational. b. Links should be made to the Archive of Clinical Casess home page (www.clinicalcases.eu) or to the articles abstract. c. It is forbidden to use the Archive of Clinical Casess cover by outside organizations unless permission has been granted in advance, notifying our Secretary. d. Material owned by the Archive of Clinical Cases (including the name, logo, cover, and text) may not be used in any manner that may induce the idea or suggest that the Archive of Clinical Cases is in some way recommending a specific company, product or service. e. You must not use or allow others to access or use, all or any part of our Site or the contents and/or applications on it for commercial purposes without our permission. To seek permission to do anything prohibited by or not contained in these TERMS, or which requires our prior consent or agreement, you can contact us.