title: Low-dose tacrolimus for two cases of myasthenia gravis with invasive thymoma that relapsed shortly after thymectomy.
abstract: Two patients with myasthenia gravis (Ossermann IIb) involving invasive thymoma who underwent extensive thymectomy manifested myasthenic crisis shortly after the procedure; however, both patients were treated with intravenous immunoglobulin and recovered from myasthenic crisis that had been deteriorating for about 1 week. Subsequently, the patients were administered a low-dose of tacrolimus (3 mg/day) in addition to prednisolone. Several months later, tacrolimus continued to control fluctuations of myasthenic symptoms and maintained remission in these patients. The serum titer of anti-Ach-receptor antibodies decreased in parallel with clinical improvement due to tacrolimus, and we accordingly reduced the dosage of prednisolone. Tacrolimus is a new immunosuppressive agent acting through the selective inhibition of helper-T-cell activation that can be reduced dosage of steroids and can maintain remission of myasthenia gravis with invasive thymoma.
authors.affiliation: Third Departement of Internal Medicine, Kagawa University School of Medicine, 1750-1 Ikenobe, Miki-cho, Kita-gun, 761-0793 Kagawa, Japan.
authors.forename: Masago
authors.initials: M
authors.lastname: Tsukaguchi
authors.forename: Mieko
authors.initials: M
authors.lastname: Shimamura
authors.forename: Kazuyo
authors.initials: K
authors.lastname: Ikeda
authors.forename: Yoshiteru
authors.initials: Y
authors.lastname: Urai
authors.forename: Iwao
authors.initials: I
authors.lastname: Sasaki
authors.forename: Kazushi
authors.initials: K
authors.lastname: Deguchi
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Touge
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Takeuchi
authors.forename: Shigeki
authors.initials: S
authors.lastname: Kuriyama
mesh_terms: D000328:Adult; D000906:Antibodies / Q000627:therapeutic use; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D004347:Drug Interactions; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000150:complications / Q000628:therapy*; D009361:Neoplasm Invasiveness; D011239:Prednisolone / Q000627:therapeutic use; D011950:Receptors, Cholinergic / Q000276:immunology; D055502:Secondary Prevention; D016559:Tacrolimus / Q000627:therapeutic use*; D013934:Thymectomy; D013945:Thymoma / Q000150:complications / Q000628:therapy*; D013997:Time Factors
chemical_list: D000906:Antibodies; D018931:Antineoplastic Agents, Hormonal; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D011950:Receptors, Cholinergic; D011239:Prednisolone; D016559:Tacrolimus