Myasthenia gravis and Lambert-Eaton myasthenic syndrome in the same patient

An 18-year-old-woman developed symptoms of generalized myasthenia gravis (MG). Antibodies to the acetylcholine receptor were found in her serum, but electrodiagnostic testing showed abnormalities typical of the Lambert-Eaton myasthenic syndrome (LEMS). Following thymectomy, the thymus gland showed thymic hyperplasia typical of MG, and the patient responded to treatment with 3,4-diaminopyridine and pyridostigmine. There have been few reports in the literature of MG and LEMS coexisting in the same patient. In this case, electrodiagnostic tests, antibody studies, thymus pathology, and response to treatment suggest that both disorders contributed to the patient's symptoms. Thymic hyperplasia, so far only known to be associated with MG, provides strong evidence that both diseases were symptomatic.