Myasthenia gravis with anti-muscle-specific tyrosine kinase antibodies during therapy for multiple myeloma: a case report
Abstract Background The onset of myasthenia (MG) gravis with anti-muscle-specific tyrosine kinase (MuSK) antibodies most commonly peaks in the fourth decade of life, and MG with MuSK antibodies (MuSK-MG) rarely coexists with a malignant tumor. To date, MuSK-MG has not been reported in multiple myelo...
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| Format: | Article |
| Language: | English |
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BMC
2020-06-01
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| Series: | BMC Neurology |
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| Online Access: | http://link.springer.com/article/10.1186/s12883-020-01813-1 |
| _version_ | 1819319786114383872 |
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| author | Shoko Sakano Hirofumi Matsuyama Hidehiro Ishikawa Akihiro Shindo Yuichiro Ii Keita Matsuura Minoru Mizutani Norikazu Kawada Hidekazu Tomimoto |
| author_facet | Shoko Sakano Hirofumi Matsuyama Hidehiro Ishikawa Akihiro Shindo Yuichiro Ii Keita Matsuura Minoru Mizutani Norikazu Kawada Hidekazu Tomimoto |
| author_sort | Shoko Sakano |
| collection | DOAJ |
| description | Abstract Background The onset of myasthenia (MG) gravis with anti-muscle-specific tyrosine kinase (MuSK) antibodies most commonly peaks in the fourth decade of life, and MG with MuSK antibodies (MuSK-MG) rarely coexists with a malignant tumor. To date, MuSK-MG has not been reported in multiple myeloma (MM). Case presentation A 60-year-old male with MM who was receiving treatment with bortezomib and thalidomide presented diplopia, ptosis, and limb weakness. A diagnosis of MM with Bence-Jones proteinuria was established when he was 56 years old, and he received chemotherapy with four courses of bortezomib and dexamethasone. Although he received thalidomide as maintenance therapy, it was discontinued a year before hospital admission because of sensory neuropathy as a side effect. Six months before hospital admission, he developed mild diplopia. One month before admission, his chemotherapy was interrupted because of viral infection and fatigability. Then he developed neck weakness and bilateral ptosis. A diagnosis of MuSK-MG was made based on neurological and serological examinations. According to the previous relevant literature, this is the first report of MuSK-MG in a patient with MM. Conclusions In patients with MM, the possibility of co-existing of autoimmune disease, including MuSK-MG, should be considered. This case emphasizes the need to still consider testing for anti-MuSK antibodies in older MM patients where there is clinical suspicion for possible MG despite negative anti-acetylcholine receptor antibodies and lacking classic MuSK MG phenotype at onset. |
| first_indexed | 2024-12-24T11:09:13Z |
| format | Article |
| id | doaj.art-a7f10a71ed9646a992b6c802be3ab317 |
| institution | Directory Open Access Journal |
| issn | 1471-2377 |
| language | English |
| last_indexed | 2024-12-24T11:09:13Z |
| publishDate | 2020-06-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Neurology |
| spelling | doaj.art-a7f10a71ed9646a992b6c802be3ab3172022-12-21T16:58:34ZengBMCBMC Neurology1471-23772020-06-012011410.1186/s12883-020-01813-1Myasthenia gravis with anti-muscle-specific tyrosine kinase antibodies during therapy for multiple myeloma: a case reportShoko Sakano0Hirofumi Matsuyama1Hidehiro Ishikawa2Akihiro Shindo3Yuichiro Ii4Keita Matsuura5Minoru Mizutani6Norikazu Kawada7Hidekazu Tomimoto8Department of Neurology, Mie University Graduate School of MedicineDepartment of Neurology, Mie University Graduate School of MedicineDepartment of Neurology, Mie University Graduate School of MedicineDepartment of Neurology, Mie University Graduate School of MedicineDepartment of Neurology, Mie University Graduate School of MedicineDepartment of Neurology, Mie University Graduate School of MedicineDepartment of Hematology, Matsusaka Central General HospitalDepartment of Neurology, Matsusaka Central General HospitalDepartment of Neurology, Mie University Graduate School of MedicineAbstract Background The onset of myasthenia (MG) gravis with anti-muscle-specific tyrosine kinase (MuSK) antibodies most commonly peaks in the fourth decade of life, and MG with MuSK antibodies (MuSK-MG) rarely coexists with a malignant tumor. To date, MuSK-MG has not been reported in multiple myeloma (MM). Case presentation A 60-year-old male with MM who was receiving treatment with bortezomib and thalidomide presented diplopia, ptosis, and limb weakness. A diagnosis of MM with Bence-Jones proteinuria was established when he was 56 years old, and he received chemotherapy with four courses of bortezomib and dexamethasone. Although he received thalidomide as maintenance therapy, it was discontinued a year before hospital admission because of sensory neuropathy as a side effect. Six months before hospital admission, he developed mild diplopia. One month before admission, his chemotherapy was interrupted because of viral infection and fatigability. Then he developed neck weakness and bilateral ptosis. A diagnosis of MuSK-MG was made based on neurological and serological examinations. According to the previous relevant literature, this is the first report of MuSK-MG in a patient with MM. Conclusions In patients with MM, the possibility of co-existing of autoimmune disease, including MuSK-MG, should be considered. This case emphasizes the need to still consider testing for anti-MuSK antibodies in older MM patients where there is clinical suspicion for possible MG despite negative anti-acetylcholine receptor antibodies and lacking classic MuSK MG phenotype at onset.http://link.springer.com/article/10.1186/s12883-020-01813-1Myasthenia gravisAnti-muscle-specific tyrosine kinase antibodiesMultiple myelomaBortezomibCase report |
| spellingShingle | Shoko Sakano Hirofumi Matsuyama Hidehiro Ishikawa Akihiro Shindo Yuichiro Ii Keita Matsuura Minoru Mizutani Norikazu Kawada Hidekazu Tomimoto Myasthenia gravis with anti-muscle-specific tyrosine kinase antibodies during therapy for multiple myeloma: a case report BMC Neurology Myasthenia gravis Anti-muscle-specific tyrosine kinase antibodies Multiple myeloma Bortezomib Case report |
| title | Myasthenia gravis with anti-muscle-specific tyrosine kinase antibodies during therapy for multiple myeloma: a case report |
| title_full | Myasthenia gravis with anti-muscle-specific tyrosine kinase antibodies during therapy for multiple myeloma: a case report |
| title_fullStr | Myasthenia gravis with anti-muscle-specific tyrosine kinase antibodies during therapy for multiple myeloma: a case report |
| title_full_unstemmed | Myasthenia gravis with anti-muscle-specific tyrosine kinase antibodies during therapy for multiple myeloma: a case report |
| title_short | Myasthenia gravis with anti-muscle-specific tyrosine kinase antibodies during therapy for multiple myeloma: a case report |
| title_sort | myasthenia gravis with anti muscle specific tyrosine kinase antibodies during therapy for multiple myeloma a case report |
| topic | Myasthenia gravis Anti-muscle-specific tyrosine kinase antibodies Multiple myeloma Bortezomib Case report |
| url | http://link.springer.com/article/10.1186/s12883-020-01813-1 |
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