title: Combined Guillain-Barré syndrome and myasthenia gravis.
abstract: BACKGROUND
  Guillain-Barré syndrome and myasthenia gravis both lead to muscle weakness but the two combined is uncommon. Detection of these entities can help identify forms of autoimmune neuromuscular diseases that may respond to immunotherapy. This report sought to characterize the clinical features of these two entities when combined.
  
  
  METHODS
  This report is of a case of combined Guillain-Barré syndrome and myasthenia gravis. The clinical features were analyzed and correlated to those published in English literature from 1960 to 2012. Ten reports and 12 cases, including the present case, were reviewed.
  
  
  RESULTS
  There were 12 patients (4 women and 8 men), aged 17 to 84 years, with combined Guillain-Barré syndrome and myasthenia gravis. Four had post-infectious Guillain-Barré syndrome followed by the development of myasthenia gravis concurrently or concomitantly within one month. All cases had symptoms of ptosis and areflexia. The other common presentations were limb weakness, oculobulbar weakness, and respiratory involvement. Functional outcome was mentioned in 10 patients and seven had good outcome (Hughes scale ≤ 2).
  
  
  CONCLUSIONS
  Detection of ptosis with or without ophthalmoplegia, distribution of limb weakness, and reflex can help in recognizing combined Guillain-Barré syndrome and myasthenia gravis. The early recognition of this combination of peripheral nervous and neuro-muscular junction inflammation is important for initial treatment and prognosis.
authors.affiliation: Division of Pediatric Neurology, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Meng-Ying
authors.initials: MY
authors.lastname: Hsieh
authors.forename: Oi-Wa
authors.initials: OW
authors.lastname: Chan
authors.forename: Jainn-Jim
authors.initials: JJ
authors.lastname: Lin
authors.forename: Kuang-Lin
authors.initials: KL
authors.lastname: Lin
authors.forename: Shao-Hsuan
authors.initials: SH
authors.lastname: Hsia
authors.forename: Huei-Shyong
authors.initials: HS
authors.lastname: Wang
authors.forename: Cheng-Hsun
authors.initials: CH
authors.lastname: Chiu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001327:Autoimmune Diseases / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D020275:Guillain-Barre Syndrome / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018908:Muscle Weakness / Q000175:diagnosis / Q000503:physiopathology; D009157:Myasthenia Gravis / Q000150:complications / Q000175:diagnosis*; D011379:Prognosis; D055815:Young Adult