Clinical Characteristics of Double Seropositive Myasthenia Gravis

Neurol India. 2024 Sep 1;72(5):1066-1069. doi: 10.4103/neurol-india.Neurol-India-D-24-00091. Epub 2024 Oct 19.

Abstract

Double seropositive myasthenia gravis (DSP-MG) has antibodies positive to both acetylcholine receptor (AChR) antibody and muscle-specific tyrosine kinase (MuSK) antibody. This study aims to delineate the clinical phenotype of DSP-MG and assess the histopathological correlation with thymoma. This is a retrospective case series conducted at a tertiary care hospital in South India between February 2018 and October 2021. We had 13 DSP-MG patients (seven females, mean age 60.77+/-14.24). The presentation was generalized in nine patients, bulbar in three, and ocular in one patient. Multi-detector computed tomography done in 11 patients showed thymoma in five and thymic hyperplasia in one. Four patients underwent thymectomy; histopathology showed Type A, B2 (n = 2), and AB thymomas. All 13 patients improved with anticholinesterases. Nine patients were administered immunosuppressants, three patients were given intravenous immunoglobulin, and a single patient underwent plasmapheresis. Our study shows that DSP-MG is more similar to the clinical phenotype of AChR-MG.

MeSH terms

  • Adult
  • Aged
  • Autoantibodies* / blood
  • Cholinesterase Inhibitors / therapeutic use
  • Female
  • Humans
  • India
  • Male
  • Middle Aged
  • Myasthenia Gravis* / blood
  • Myasthenia Gravis* / diagnosis
  • Receptor Protein-Tyrosine Kinases* / immunology
  • Receptors, Cholinergic* / immunology
  • Retrospective Studies
  • Thymectomy
  • Thymoma* / diagnostic imaging
  • Thymus Neoplasms

Substances

  • Receptors, Cholinergic
  • Autoantibodies
  • Receptor Protein-Tyrosine Kinases
  • MUSK protein, human
  • Cholinesterase Inhibitors