Background: Systemic lupus erythematosus (SLE) is one of the autoimmune diseases, which is rarely reported with Myasthenia Gravis (MG). In the literature, the clinical features of MG in these patients were not mentioned in detail. Here, we want to present our five patients with MG and SLE. Methods: Between 2000 and 2010, 132 MG patients were evaluated and have been followed up in our institution. Five patients had MG with SLE and eleven patients had antinuclear antibody (ANA) positivity without SLE symptoms. The clinical, laboratory findings and treatment responses were reviewed. Results: All patients had generalized MG and four of five patients experienced at least one myasthenic crisis. The response to corticosteroid was poor; consequently, they needed immunosuppressive treatments, IVIg or plasmapheresis. Although in the literature thymectomy was accused of the precipitation of SLE, in our series SLE symptoms preceded thymectomy. Conclusion: We would like to point out that MG and SLE being two autoimmune diseases may coexist. This coexistence might cause a more severe myasthenic course compared to MG alone; therefore, these patients need a close and frequent follow-up.

1.
Zivković SA, Medsger TA Jr: Myasthenia gravis and scleroderma: two cases and a review of the literature. Clin Neurol Neurosurg 2007;109:388-391.
2.
Téllez-Zenteno JF, Cardenas G, Estañol B, Garcia-Ramos G, Weder-Cisneros N: Associated conditions in myasthenia gravis: response to thymectomy. Eur J Neurol 2004;11:767-773.
3.
Hill EK, King PH, Hughey LC: Dermatomyositis and concomitant overlap myasthenic syndrome: a rare presentation. J Am Acad Dermatol 2011;65:150-152.
4.
Jarius S, Paul F, Franciotta D, de Seze J, Münch C, Salvetti M, Ruprecht K, Liebetrau M, Wandinger KP, Akman-Demir G, Melms A, Kristoferitsch W, Wildemann B: Neuromyelitis optica spectrum disorders in patients with myasthenia gravis: ten new aquaporin-4 antibody positive cases and a review of the literature. Mult Scler 2012;18:1135-1143.
5.
Jallouli M, Saadoun D, Eymard B, Leroux G, Haroche J, Le Thi Huong D, De Gennes C, Chapelon C, Benveniste O, Wechsler B, Cacoub P, Amoura Z, Piette JC, Costedoat-Chalumeau N: The association of systemic lupus erythematosus and myasthenia gravis: a series of 17 cases, with a special focus on hydroxychloroquine use and a review of the literature. J Neurol 2012;259:1290-1297.
6.
Park MJ, Kim YA, Lee SS, Kim BC, Kim BK, Cho KH: Appearance of systemic lupus erythematosus in patients with myasthenia gravis following thymectomy: two case reports. J Korean Med Sci 2004;19:134-136.
7.
Sthoeger Z, Neiman A, Elbirt D, Zinger H, Magen E, Burstein R, Eitan S, Abarbanel J, Mozes E: High prevalence of systemic lupus erythematosus in 78 myasthenia gravis patients: a clinical and serologic study. Am J Med Sci 2006;331:4-9.
8.
Bekircan-Kurt CE, Kurne A, Erdem-Özdamar S, Karabudak R, Kansu T, Tan E: Myasthenia Gravis; Single Entity, Variable Clinical Features: Ten Years of Clinical Experience in a Tertiary Care Center Ten Years Clinical Experience of a Tertiary Care Center. J Neurol Sci (Turkish) 2013;30:135-143.
9.
Hrycek A: Systemic lupus erythematosus and myasthenia gravis. Pol Arch Med Wewn 2009;119:582-585.
10.
Gerli R, Paganelli R, Cossarizza A, Muscat C, Piccolo G, Barbieri D, Mariotti S, Monti D, Bistoni O, Raiola E, Venanzi FM, Bertotto A, Franceschi C: Long-term immunologic effects of thymectomy in patients with myasthenia gravis. J Allergy Clin Immunol 1999;103:865-872.
11.
Moreth K, Brodbeck R, Babelova A, Gretz N, Spieker T, Zeng-Brouwers J, Pfeilschifter J, Young MF, Schaefer RM, Schaefer L: The proteoglycan biglycan regulates expression of the B cell chemoattractant CXCL13 and aggravates murine lupus nephritis. J Clin Invest 2010;120:4251-4272.
12.
Lee HT, Shiao YM, Wu TH, Chen WS, Hsu YH, Tsai SF, Tsai CY: Serum BLC/CXCL13 concentrations and renal expression of CXCL13/CXCR5 in patients with systemic lupus erythematosus and lupus nephritis. J Rheumatol 2010;37:45-52.
13.
Shiao YM, Lee CC, Hsu YH, Huang SF, Lin CY, Li LH, Fann CS, Tsai CY, Tsai SF, Chiu HC: Ectopic and high CXCL13 chemokine expression in myasthenia gravis with thymic lymphoid hyperplasia. J Neuroimmunol 2010;221:101-106.
14.
Meraouna A, Cizeron-Clairac G, Panse RL, Bismuth J, Truffault F, Tallaksen C, Berrih-Aknin S: The chemokine CXCL13 is a key molecule in autoimmune myasthenia gravis. Blood 2006;108:432-440.
15.
Costedoat-Chalumeau N, Amoura Z, Hulot JS, Lechat P, Piette JC: Hydroxychloroquine in systemic lupus erythematosus. Lancet 2007;369:1257-1258.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.