Myasthenia gravis and stroke in the setting of giant cell arteritis

Area of Science:

• Neurology
• Rheumatology
• Internal Medicine

Background:

• Myasthenia gravis (MG) is an autoimmune disorder affecting neuromuscular junctions.
• Giant cell arteritis (GCA) is a systemic vasculitis primarily affecting large and medium arteries.
• Co-occurrence of MG and GCA is exceptionally rare in clinical literature.

Purpose of the Study:

• To report a unique case of a patient diagnosed with both myasthenia gravis and giant cell arteritis.
• To emphasize the diagnostic challenges and considerations when faced with overlapping or independent chronic diseases.

Main Methods:

• Case report of a 79-year-old female patient presenting with stroke.
• Clinical evaluation for symptoms suggestive of myasthenia gravis (ptosis, dysphagia, weakness).
• Diagnostic workup for suspected giant cell arteritis (fever, elevated inflammatory markers, visual changes), confirmed by histology. Serological tests for acetylcholine receptor antibodies.

Main Results:

• The patient presented with stroke symptoms and subsequently exhibited signs of both myasthenia gravis and giant cell arteritis.
• Histological examination confirmed giant cell arteritis.
• Presence of muscle acetylcholine receptor antibodies supported the diagnosis of myasthenia gravis.

Conclusions:

• This case underscores the necessity of considering multiple independent diagnoses when a single condition cannot fully explain a patient's complex clinical presentation.
• The coexistence of myasthenia gravis and giant cell arteritis presents a diagnostic challenge, requiring a comprehensive approach.
• Clinicians should maintain a high index of suspicion for coexisting pathologies in complex patient cases.