Primary progressive multiple sclerosis and generalized myasthenia gravis: an uncommon association.
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.
Bigliardi
G
G
Department of Neurological Sciences, University of Modena and Reggio Emilia, Modena, Italy.
Mandrioli
J
J
Valzania
F
F
Nichelli
P
P
Casula
N
N
Simone
A M
AM
Sola
P
P
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