title: Primary progressive multiple sclerosis and generalized myasthenia gravis: an uncommon association.
abstract: The co-occurrence of myasthenia gravis (MG) and multiple sclerosis (MS) is rare, and in all the described cases MS had a relapsing-remitting course and the diseases had a benign clinical evolution. We describe herewith a patient with primary progressive MS (PPMS) and generalized MG with severe clinical course. This is the first report on a case of PPMS associated to MG. Studies on the histology and pathogenesis show that neurodegeneration is predominant over inflammation in PPMS, even if cellular and humoral immune-mediated mechanisms are thought to maintain a crucial importance in the development and progression of this form of disease. In the present case, the detection of cerebrospinal fluid IgM oligoclonal bands support the hypothesis of a possible role of antibody-mediated immunity in PPMS and suggest that humoral immunity may take part in the concomitant development of both MS and MG.
authors.affiliation: Department of Neurological Sciences, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Bigliardi
authors.forename: J
authors.initials: J
authors.lastname: Mandrioli
authors.forename: F
authors.initials: F
authors.lastname: Valzania
authors.forename: P
authors.initials: P
authors.lastname: Nichelli
authors.forename: N
authors.initials: N
authors.lastname: Casula
authors.forename: A M
authors.initials: AM
authors.lastname: Simone
authors.forename: P
authors.initials: P
authors.lastname: Sola
mesh_terms: D015897:Comorbidity; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D020528:Multiple Sclerosis, Chronic Progressive / Q000150:complications* / Q000175:diagnosis / Q000276:immunology; D009157:Myasthenia Gravis / Q000150:complications* / Q000175:diagnosis / Q000276:immunology; D012720:Severity of Illness Index