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Myasthenia gravis, castleman disease, pemphigus, and anti-phospholipid syndrome

Authors

  • Michala Jakubíková MD,

    Corresponding author
    • Department of Neurology and Center of Clinical Neuroscience, Charles University Prague, First Faculty of Medicine and General University Hospital, Czech Republic
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  • Jiří Piťha MD,

    1. Department of Neurology and Center of Clinical Neuroscience, Charles University Prague, First Faculty of Medicine and General University Hospital, Czech Republic
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  • Jan Latta MD,

    1. Department of Neurology University Pardubice and Regional Hospital Pardubice, Faculty of Health Studies, Czech Republic
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  • Edvard Ehler MD, PhD,

    1. Department of Neurology University Pardubice and Regional Hospital Pardubice, Faculty of Health Studies, Czech Republic
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  • Jan Schutzner MD, PhD

    1. Third Department of Surgery, First Faculty of Medicine, Charles University in Prague and University Hospital Motol, Czech Republic
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Department of Neurology and Center of Clinical Neuroscience, Charles University Prague, First Faculty of Medicine and General University Hospital, Prague Kateřinská 30, 128 01 Praha 2, Czech Republic. E-mail: michala.jakubikova@vfn.cz

Abstract

Introduction: Myasthenia gravis is an autoimmune disease marked by neuromuscular transmission failure at the neuromuscular junction. Castleman disease is a rare lymphoproliferative disease characterized by non-cancerous angiofolicular hyperplasia of lymphatic tissue. Methods and results: We describe a young man with rapid, successive manifestations of myasthenia gravis, a solitary form of Castleman disease, pemphigus vulgaris, and anti-phospholipid syndrome, which resulted in 2 ischemic cerebrovascular events that caused a severe central neurological deficit. Discussion: We were unable to find a similar case in the literature, but we hypothesize that the temporal concidence of these clinical entities may be related to a common immunological pathway, such as B-cell activation. Therefore, we treated the patient with an immunosuppressant and anticoagulant treatment, as well as rituximab, a monoclonal antibody therapy against CD20+. Muscle Nerve 47:447-451, 2013

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