Low-dose tacrolimus for two cases of myasthenia gravis with invasive thymoma that relapsed shortly after thymectomy.
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.
Tsukaguchi
Masago
M
Third Departement of Internal Medicine, Kagawa University School of Medicine, 1750-1 Ikenobe, Miki-cho, Kita-gun, 761-0793 Kagawa, Japan.
Shimamura
Mieko
M
Ikeda
Kazuyo
K
Urai
Yoshiteru
Y
Sasaki
Iwao
I
Deguchi
Kazushi
K
Touge
Tetsuo
T
Takeuchi
Hiroaki
H
Kuriyama
Shigeki
S
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
D000906:Antibodies; D018931:Antineoplastic Agents, Hormonal; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D011950:Receptors, Cholinergic; D011239:Prednisolone; D016559:Tacrolimus