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Acetylcholine receptor antibody-positive myasthenia gravis associated with small-cell lung cancer: A case report.

Abstract Only few cases of myasthenia gravis (MG) associated with small-cell lung cancer (SCLC) have been reported, and cases positive for acetylcholine receptor antibody (AChR-ab) are even rarer. The efficacy of standard MG treatment, such as cholinesterase inhibitor therapy, immunosuppressive therapy using steroids and immunosuppressive drugs, plasma exchange, and intravenous immune globulin (IVIg), for these cases is unclear.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 29703032
OWN - NLM
STAT- MEDLINE
DCOM- 20180507
LR  - 20180507
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 97
IP  - 17
DP  - 2018 Apr
TI  - Acetylcholine receptor antibody-positive myasthenia gravis associated with
      small-cell lung cancer: A case report.
PG  - e0541
LID - 10.1097/MD.0000000000010541 [doi]
AB  - RATIONALE: Only few cases of myasthenia gravis (MG) associated with small-cell
      lung cancer (SCLC) have been reported, and cases positive for acetylcholine
      receptor antibody (AChR-ab) are even rarer. The efficacy of standard MG
      treatment, such as cholinesterase inhibitor therapy, immunosuppressive therapy
      using steroids and immunosuppressive drugs, plasma exchange, and intravenous
      immune globulin (IVIg), for these cases is unclear. PATIENT CONCERNS AND
      DIAGNOSES: A 71-year-old man complained of bilateral eyelid ptosis. He also
      presented with dysphagia and masticatory muscle fatigue after chewing. The
      edrophonium test was positive, and the serum AChR-ab level was increased;
      therefore, the patient was diagnosed with MG. Computed tomography scan showed a
      nodule on the left upper lobe of the lung and mediastinal lymphadenopathy.
      Further examination revealed the lesion as SCLC. Finally, he was diagnosed with
      AChR-ab-positive MG associated with SCLC. INTERVENTIONS AND OUTCOMES: Oral
      pyridostigmine and tacrolimus were administered to treat MG; however, his
      symptoms worsened. Therefore, methylprednisolone and IVIg were administrated,
      which temporarily improved his symptoms. However, they remained uncontrolled.
      Meanwhile, chemotherapy with carboplatin and etoposide was administered to treat 
      his SCLC. The lesions shrunk, and the MG symptoms and serum AChR-ab level also
      improved. LESSONS: AChR-ab-positive MG may develop as a comorbidity of SCLC. In
      such cases, management might require treatment for SCLC in addition to the
      standard MG treatment to stabilize the MG symptoms.
FAU - Yamasaki, Masahiro
AU  - Yamasaki M
AD  - Department of Respiratory Disease, Hiroshima Red Cross Hospital & Atomic Bomb
      Survivors Hospital, Naka-ku.
FAU - Funaishi, Kunihiko
AU  - Funaishi K
AD  - Department of Respiratory Disease, Hiroshima Red Cross Hospital & Atomic Bomb
      Survivors Hospital, Naka-ku.
FAU - Saito, Naomi
AU  - Saito N
AD  - Department of Respiratory Medicine, Mazda Hospital, Aki-gun.
FAU - Yonekawa, Tomomi
AU  - Yonekawa T
AD  - Department of Neurology, Hiroshima Red Cross Hospital & Atomic Bomb Survivors
      Hospital, Naka-ku, Hiroshima, Japan.
FAU - Yamawaki, Takemori
AU  - Yamawaki T
AD  - Department of Neurology.
FAU - Ihara, Daisuke
AU  - Ihara D
AD  - Department of Respiratory Medicine, Hiroshima City Hiroshima Citizens Hospital,
      Naka-ku, Hiroshima.
FAU - Daido, Wakako
AU  - Daido W
AD  - Department of Respiratory Disease, Hiroshima Red Cross Hospital & Atomic Bomb
      Survivors Hospital, Naka-ku.
FAU - Ishiyama, Sayaka
AU  - Ishiyama S
AD  - Department of Respiratory Disease, Hiroshima Red Cross Hospital & Atomic Bomb
      Survivors Hospital, Naka-ku.
FAU - Deguchi, Naoko
AU  - Deguchi N
AD  - Department of Respiratory Disease, Hiroshima Red Cross Hospital & Atomic Bomb
      Survivors Hospital, Naka-ku.
FAU - Taniwaki, Masaya
AU  - Taniwaki M
AD  - Department of Respiratory Disease, Hiroshima Red Cross Hospital & Atomic Bomb
      Survivors Hospital, Naka-ku.
FAU - Hattori, Noboru
AU  - Hattori N
AD  - Department of Molecular and Internal Medicine, Institute of Biomedical & Health
      Sciences, Hiroshima University, Minami-ku, Hiroshima, Japan.
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Autoantibodies)
RN  - 0 (Receptors, Cholinergic)
SB  - AIM
SB  - IM
MH  - Aged
MH  - Autoantibodies/*blood
MH  - Humans
MH  - Lung Neoplasms/blood/*immunology
MH  - Male
MH  - Myasthenia Gravis/blood/*immunology
MH  - Receptors, Cholinergic/*immunology
MH  - Small Cell Lung Carcinoma/blood/*immunology
EDAT- 2018/04/29 06:00
MHDA- 2018/05/08 06:00
CRDT- 2018/04/29 06:00
PHST- 2018/04/29 06:00 [entrez]
PHST- 2018/04/29 06:00 [pubmed]
PHST- 2018/05/08 06:00 [medline]
AID - 10.1097/MD.0000000000010541 [doi]
AID - 00005792-201804270-00064 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2018 Apr;97(17):e0541. doi: 10.1097/MD.0000000000010541.