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Título

Myasthenia Gravis in association with Guillain Barre Syndrome: a case report

RESUMO

Case presentation: A 48-year-old male was diagnosed with Myasthenia Gravis (MG) five years ago, when presenting paresis in the all four limbs, eyelid ptosis and difficulty in swallowing, symptoms currently controlled with the use of pyridostigmine bromide and corticosteroid therapy. Concomitantly, thymoma was also detected and treated with thymectomy, radiotherapy and chemotherapy, getting complete remission. In April 2022, the patient sought an emergency care unit (ECU) due to fever and diffuse joint pain, being diagnosed with Chikungunya and medicated with analgesics. After a week, he evolved with paresis in the lower limbs, difficulty in locomotion, and paresthesias in the feet and hands, looking again for the ECU, where he was medicated with betamethasone. However, he evolved into urinary incontinence and progression of paresthesia to the trunk and upper limbs, being referred to the State General Hospital, where he was diagnosed with Guillain B arré syndrome (GBS), treated with plasmapheresis for 10 days. He currently has grade 5 strength in all limbs and preserved tactile, painful, and vibration sensitivities, only complaining of diffuse paresthesias. Discussion: GBS and MG are autoimmune neurological diseases. MG is caused by the action of anti-acetylcholine receptor antibodies, causing neuromuscular junction dysfunction and culminating in fluctuating muscle weakness. MG is often associated with thymomas, as described in the case, especially in the presence of positive antibody to AChR (AChR-MG). GBS is an acute inflammatory polyneuropathy, caused by the action of autoantibodies that act against myelin proteins or against components of peripheral nerve axons, often triggered by infections, in this case Chikungunya. It is estimated that the frequency of co-occurrence of MG and GBS, as in the case in question, is less than 1 in 10 billion. Final comments: Although comorbidity of GBS and MG is extremely rare, early recognition of this combination of inflammation of peripheral nerves and the dysfunction of neuromuscular junction is of great importance for both initial treatment and a better prognosis.

Palavras Chave

Myasthenia Gravis; Guillain Barre Syndrome; Neuromuscular disorders