Association of myasthenia gravis with pemphigus vulgaris, Candida albicans infection, polymyositis and myocarditis.
نویسندگان
چکیده
A 52-year-old man developed diplopia, followed in 3 weeks by ptosis, more pronounced on the right, slight difficulty in talking, chewing, and swallowing, with nasal regurgitation, and mild weakness of the muscles of the neck and limbs. Family and past history were not contributory. There was bilateral ptosis, and the maximum width of the palpebral fissure on upward gaze was 8 mm on the right and 8.5 mm on the left, which became 5 mm and 6.5 mm, respectively, after maintaining upward gaze for I min. The orbiculares oculi were moderately weak, and the neck flexors and arm elevators were slightly weak. Eye movements were normal, and there was no other detectable weakness or wasting of muscle. Ptosis disappeared tempo rarily following intravenous injection of edrophonium chloride. Radiologic examination of the chest was normal. The serum globulin bound to cross-striations of skeletal muscle at a titer of I : 810 (normal, less than I :90) and reacted with isolated human skeletal muscle membrane by the complement fixation method at a titer of 1.63 units (normal, 0-:94 units). Antinuclear antibody and rheumatoid factor were negative. A diag nosis of mild, generalized myasthenia gravis was made. The symptoms were controlled by the oral admini stration of 90 mg pyridostigmine bromide every 3 hr during the daytime. The course was uneventful until 10 months after the onset of the disease, when the patient developed aggravation of ptosis, abdominal cramps, and diarrhea, following pyridostigmine administration. Reduc tion in the dose of pyridostigmine alleviated ptosis and abdominal complaints, but caused marked weakness of the shoulder girdle muscles and of swallowing, voice, and breathing, indicating different responsiveness
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عنوان ژورنال:
- Journal of the neurological sciences
دوره 20 2 شماره
صفحات -
تاریخ انتشار 1973