Min Seob Cha; Yu Ri Choi; Min Seob Kwak; Chan Hee Lee; Jeong Hee Cho; Il Saeng Choi; Sun Jung Kim

doi:10.4078/jkra.2010.17.4.437

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Cha, Choi, Kwak, Lee, Cho, Choi, and Kim: Co-occurrence of Myasthenia Gravis in a Patient with Systemic Sclerosis-Sjögren's Syndrome without D-penicillamine Therapy

Original Article

J Korean Rheum Assoc 2010;17(4):437-441.

Published online: 23 December 2010

DOI: https://doi.org/10.4078/jkra.2010.17.4.437

Co-occurrence of Myasthenia Gravis in a Patient with Systemic Sclerosis-Sjögren's Syndrome without D-penicillamine Therapy

Min Seob Cha¹, Yu Ri Choi¹, Min Seob Kwak¹, Chan Hee Lee¹, Jeong Hee Cho², Il Saeng Choi², Sun Jung Kim³

¹Departments of Internal Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea

²Departments of Neurology, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea

³Departments of Nuclear Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea

Received 30 August 201013 September 2010 Accepted 14 September 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Systemic sclerosis is an autoimmune disease characterized by progressive fibrosis of the skin and visceral organs. Myasthenia gravis is also an autoimmune disease characterized by weakness and fatigue of skeletal muscles. The symptoms of systemic sclerosis and myasthenia gravis overlap clinically, so the recognition of disease co-occurrence may be delayed. Co-occurrence of myasthenia gravis and systemic sclerosis is very uncommon and usually diagnosed after use of D-penicillamine for treating the systemic sclerosis. We report a case of a 49-year-old female patient who complained of general weakness and was diagnosed with myasthenia gravis. Four months earlier she was diagnosed with systemic sclerosis with Sjögren's syndrome and her medications did not include D-penicillamine.

Keywords: Scleroderma, Myasthenia gravis, Sjögren's syndrome

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Fig. 1.

Salivary gland scan showed diffusely decreased uptake of radiotracer in the bilateral parotid (arrows) and submandibular glands (arrow heads).

Fig. 2.

Repetitive nerve stimulation test revealed a decremental response in the right flexor carpi ulnaris muscle of more than 10% at a low stimulation rate (5 Hz), (A) but no decremental response in the right orbicularis oculi muscle (B).

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