title: Anti-aquaporin-4 antibody-positive definite neuromyelitis optica in a patient with thymectomy for myasthenia gravis.
abstract: BACKGROUND
  Since serum anti-aquaporin-4 (AQP4) antibody/neuromyelitis optica (NMO)-IgG has been detected as a specific biomarker for NMO), new diagnostic criteria have been proposed. Recently, a rare coexistence of NMO and myasthenia gravis (MG) has been documented. Here, we provide further evidence of the association of these 2 immunologic disorders and review the literature.
  
  
  METHODS
  A 60-year-old woman, who had a history of optic neuritis at age 43, developed longitudinally extended transverse myelitis (LETM). She had repeated optic neuritis and longitudinally extended transverse myelitis attacks, which have been treated by corticosteroid pulse therapy. She was diagnosed as having definite NMO, because serum anti-aquaporin-4 antibody was positive. She had also been suffering from generalized MG since age 30 and underwent thymectomy at age 40. There have been 14 patients with NMO associated with MG, most of whom developed NMO years after thymectomy. Our patient is the seventh patient with seropositive NMO who underwent thymectomy for MG.
  
  
  CONCLUSIONS
  The coexistence of MG with thymectomy and seropositive NMO suggests an etiopathogenic link between these 2 disorders but remains underrecognized by neurologists. Neurologists should consider this possible association when encountering atypical presentations of either MG or NMO.
authors.affiliation: Department of Neurology, Juntendo University Shizuoka Hospital, Izunokuni, Japan.
authors.forename: Kotaro
authors.initials: K
authors.lastname: Ogaki
authors.forename: Takashi
authors.initials: T
authors.lastname: Hirayama
authors.forename: Karina
authors.initials: K
authors.lastname: Chijiiwa
authors.forename: Jiro
authors.initials: J
authors.lastname: Fukae
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Furuya
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Noda
authors.forename: Kenji
authors.initials: K
authors.lastname: Fujishima
authors.forename: Nobutaka
authors.initials: N
authors.lastname: Hattori
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Takahashi
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Okuma
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D051401:Aquaporin 4 / Q000276:immunology*; D001323:Autoantibodies / Q000096:biosynthesis* / Q000097:blood*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000150:complications* / Q000276:immunology / Q000601:surgery; D009471:Neuromyelitis Optica / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D013934:Thymectomy
chemical_list: C496030:AQP4 protein, human; D000305:Adrenal Cortex Hormones; D051401:Aquaporin 4; D001323:Autoantibodies