title: Fatal Morvan Syndrome Associated With Myasthenia Gravis.
abstract: BACKGROUND
  Morvan syndrome is a rare and complex autoimmune disorder affecting multiple sites of neuraxis.
  
  
  METHODS
  We present fulminant Morvan syndrome, developing on a background of chronic myasthenia gravis. A 54-year-old gentleman presented with fluctuating ophthalmoplegia and proximal muscles weakness of 7 years duration that remitted with pyridostigmine and prednisolone. He developed insomnia of 2 months duration, worsening of myasthenic symptoms and respiratory distress, dysautonomia, encephalopathy, and peripheral nerve hyperexcitability. Antibodies against contactin-associated protein (CASPR) 2 were detected in serum. Computed tomography of thorax showed a thymic mass. He received intravenous methyl prednisolone and plasmapheresis. Antibodies against CASPR and thymic lesion reduced with immunotherapy. However, he developed persistent hypotension and expired after 11 weeks of hospital stay.
  
  
  CONCLUSIONS
  Clinical clues for diagnosis of Morvan syndrome and therapeutic changes faced by the treating team are highlighted in this report. Increased awareness and prompt testing for CASPR2 antibody is warranted so that early immunotherapy can be initiated.
authors.affiliation: Departments of *Neurology †Neuropathology ‡Neuro-Imaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India.
authors.forename: Madhu
authors.initials: M
authors.lastname: Nagappa
authors.forename: Anita
authors.initials: A
authors.lastname: Mahadevan
authors.forename: Sanjib
authors.initials: S
authors.lastname: Sinha
authors.forename: Parayil S
authors.initials: PS
authors.lastname: Bindu
authors.forename: Pavagada S
authors.initials: PS
authors.lastname: Mathuranath
authors.forename: Cheminikara
authors.initials: C
authors.lastname: Bineesh
authors.forename: Rose D
authors.initials: RD
authors.lastname: Bharath
authors.forename: Arun B
authors.initials: AB
authors.lastname: Taly
mesh_terms: D017809:Fatal Outcome; D006801:Humans; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000150:complications / Q000175:diagnosis*; D020385:Myokymia / Q000175:diagnosis* / Q000209:etiology