title: Giant cell myositis responsive to combined corticosteroids and immunoglobulin.
abstract: A 70-year-old man presented with respiratory distress and proximal muscle weakness shortly after biopsy of a left forearm mass. The biopsy showed giant cell myositis, and serological investigations identified a grossly elevated serum creatine kinase level, suggesting skeletal muscle damage. Serum troponin T was also high, but troponin I was normal. Serum antiacetylcholine receptor antibodies were positive, and imaging showed a thymoma. He recovered well following intravenous immunoglobulin and corticosteroids, and later underwent thymectomy. He is currently in sustained remission, with no clinically detectable myasthenia, but subsequently, developed hypogammaglobulinaemia. Neurologists should remember giant cell myositis/myocarditis can occur in patients who have myasthenia gravis with thymoma, as it is potentially fatal, but may respond to immunosuppression.
authors.affiliation: Department of Neurology, Derriford Hospital, Plymouth Hospitals NHS Trust, Plymouth, UK.
authors.forename: A
authors.initials: A
authors.lastname: Shah
authors.affiliation: Department of Neurology, Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Manchester, UK.
authors.forename: A
authors.initials: A
authors.lastname: Pace
authors.affiliation: Department of Neuropathology, Derriford Hospital, Plymouth Hospitals NHS Trust, Plymouth, UK.
authors.forename: D
authors.initials: D
authors.lastname: Hilton
authors.affiliation: Department of Neurology, Derriford Hospital, Plymouth Hospitals NHS Trust, Plymouth, UK.
authors.forename: E
authors.initials: E
authors.lastname: Househam
authors.affiliation: Department of Neurology, Derriford Hospital, Plymouth Hospitals NHS Trust, Plymouth, UK.
authors.forename: S
authors.initials: S
authors.lastname: Weatherby
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000368:Aged; D015726:Giant Cells / Q000473:pathology*; D006801:Humans; D007136:Immunoglobulins / Q000627:therapeutic use*; D007155:Immunologic Factors / Q000627:therapeutic use*; D008279:Magnetic Resonance Imaging; D008297:Male; D018482:Muscle, Skeletal / Q000473:pathology; D009220:Myositis / Q000188:drug therapy* / Q000473:pathology; D017695:Soft Tissue Injuries
chemical_list: D000305:Adrenal Cortex Hormones; D007136:Immunoglobulins; D007155:Immunologic Factors
keywords: CARDIOLOGY; MUSCLE DISEASE; MYASTHENIA; NEUROIMMUNOLOGY; NEUROPATHOLOGY, MUSCLE