Successful treatment of MuSK antibody-positive myasthenia gravis with rituximab.
We report on a 56-year-old woman with muscle-specific receptor tyrosine kinase (MuSK) antibody-positive myasthenia with predominant bulbar symptoms and respiratory insufficiency. Conventional immunosuppression (prednisolone, azathioprine, mycophenolate mofetil) could not maintain the clinical improvement initially achieved by repeated plasma exchanges. Therefore, treatment with rituximab was initiated. After 2 months of rituximab treatment, remarkable clinical improvement correlating with a reduction of MuSK serum antibodies was seen. The patient continued to remain stable 12 months after initiation of therapy. This case report demonstrates that rituximab may be an effective and tolerable treatment in MuSK antibody-positive myasthenia gravis.
Hain
Berit
B
Department of Neurology, Martin Luther University of Halle-Wittenberg, Ernst-Grube-Strasse 40, 06120 Halle/Saale, Germany. berit.jordan@medizin.uni-halle.de
Jordan
Karin
K
Deschauer
Marcus
M
Zierz
Stephan
S
D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use; D000906:Antibodies / Q000032:analysis; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D001402:B-Lymphocytes / Q000276:immunology / Q000378:metabolism; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000378:metabolism; D007075:Immunoglobulin M / Q000378:metabolism; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000188:drug therapy* / Q000235:genetics / Q000276:immunology; D009173:Mycophenolic Acid / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D010951:Plasma Exchange; D011239:Prednisolone / Q000009:adverse effects / Q000627:therapeutic use; D020794:Receptor Protein-Tyrosine Kinases / Q000235:genetics* / Q000276:immunology; D011950:Receptors, Cholinergic / Q000235:genetics* / Q000276:immunology; D000069283:Rituximab; D013601:T-Lymphocytes / Q000276:immunology / Q000378:metabolism
D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D000906:Antibodies; D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D007166:Immunosuppressive Agents; D011950:Receptors, Cholinergic; D000069283:Rituximab; D011239:Prednisolone; C095714:MUSK protein, human; D020794:Receptor Protein-Tyrosine Kinases; D009173:Mycophenolic Acid