Minimal change disease in a patient with myasthenia gravis: A case report.
BACKGROUND
Myasthenia gravis superimposed with proteinuria is a very rare disorder with only 39 cases reported so far. Of these cases, the most commonly associated disorder is minimal change disease. Myasthenia gravis and minimal change disease are both related to the dysfunction of T lymphocytes and hence the 2 disorders may be connected.


METHODS
Here we report the first case on a patient diagnosed with myasthenia gravis concurrently with the minimal change disease, and it was presented in the absence of thymoma or thymic hyperplasia.


RESULTS
Treatment for myasthenia gravis also lowered proteinuria of minimal change disease. He ever experienced good control for myasthenia gravis and minimal change disease. However, pneumonia related septic shock occurred to him and finally he was dead. Minimal change disease is generally considered to occur subsequent to the onset of myasthenia gravis with causal association. After extensive literature review, we noted only 47.8% minimal change disease had occurred after the onset of myasthenia gravis.


CONCLUSIONS
Minimal change disease mostly occurs in children and if diagnosed in adults, clinicians should search for a potential cause such as myasthenia gravis and other associated thymic disorders.
aDepartment of Family Medicine, Cheng Ching General Hospital bDivision of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital cSchool of Medicine, China Medical University dDepartment of Life Science, Tunghai University, Taichung eDepartment of Medicine, Nation Yang Ming University, Taipei, Taiwan.
Jun-Li
JL
Tsai
Shang-Feng
SF
Tsai
D000369:Aged, 80 and over; D001706:Biopsy; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging*; D008297:Male; D009157:Myasthenia Gravis / Q000150:complications* / Q000175:diagnosis / Q000276:immunology; D009402:Nephrosis, Lipoid / Q000175:diagnosis / Q000209:etiology* / Q000276:immunology; D013601:T-Lymphocytes / Q000276:immunology / Q000473:pathology; D014057:Tomography, X-Ray Computed
Nihon Jinzo Gakkai Shi. 2000 Jul;42(5):394-8
10998921
Indian J Nephrol. 2013 Jan;23(1):75-6
23580814
Am J Kidney Dis. 1999 May;33(5):e4
10213666
Am J Med. 1972 May;52(5):699-706
4554878
Singapore Med J. 1990 Feb;31(1):46-7
2333543
Nephrol Dial Transplant. 2005 Jun;20(6):1075-82
15788438
Chest. 1980 May;77(5):695-7
6444865
Arch Intern Med. 1974 Aug;134(2):374-9
4602050
Cancer. 1980 Jan 15;45(2):387-91
7351020
Kyobu Geka. 2006 Mar;59(3):247-50
16529002
Rinsho Shinkeigaku. 2012;52(11):1303-5
23196599
Am J Nephrol. 1998;18(1):61-3
9481441
N Engl J Med. 1994 Jun 23;330(25):1797-810
8190158
Rev Pneumol Clin. 2009 Oct;65(5):322-4
19878810