title: Lambert-Eaton myasthenic syndrome associated with idiopathic thrombocytopenic purpura and diffuse panbronchiolitis: long-term remission after a course of intravenous immunoglobulin combined with low-dose prednisolone.
abstract: We report a case of Lambert-Eaton myasthenic syndrome (LEMS) associated with idiopathic thrombocytopenic purpura (ITP) and diffuse panbronchiolitis (DPB). An extensive search for malignancy yielded negative results. Interestingly, ITP and DPB developed simultaneously when the patient suffered from myasthenic symptoms. This is the first report in the Japanese or English literature of an association of LEMS, ITP, and DPB. The use of cholinesterase blocker alone did not improve the myasthenic symptoms, and the symptoms and signs relapsed with the tapering of prednisolone (PSL) dosage. However, after administration of immunoglobulin (IVIG) (0.4 g/kg/day x 5 days), low-dose PSL (20 mg/day) alleviated the LEMS and ITP, and the diseases have remained in remission for 8 months without additional IVIG. We suspect that there is a synergistic relationship between IVIG and PSL.
authors.affiliation: Department of Neurology, Graduate School of Medicine, University of Tokyo, Japan. qyk12031@nifty.ne.jp
authors.forename: T
authors.initials: T
authors.lastname: Takata
authors.forename: S
authors.initials: S
authors.lastname: Koide
authors.forename: K
authors.initials: K
authors.lastname: Ogata
authors.forename: M
authors.initials: M
authors.lastname: Motomura
authors.forename: T
authors.initials: T
authors.lastname: Yoshimura
authors.forename: R
authors.initials: R
authors.lastname: Hanajima
authors.forename: M
authors.initials: M
authors.lastname: Sakurai
authors.forename: I
authors.initials: I
authors.lastname: Kanazawa
mesh_terms: D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001988:Bronchiolitis / Q000150:complications* / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D015624:Lambert-Eaton Myasthenic Syndrome / Q000150:complications* / Q000188:drug therapy*; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage / Q000627:therapeutic use*; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000150:complications* / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D016756:Immunoglobulins, Intravenous; D011239:Prednisolone