Nocardiosis—an uncommon infection in patients with myasthenia gravis: report of three cases and review of literature

Nocardiosis is a rare infection in patients with myasthenia gravis (MG). We identified three cases of MG admitted with nocardiosis in our unit. We performed systematic literature search of previous publications and identified 18 patients. This paper presents three patients and reviews the clinical characteristics of 21 patients. The first case was a 69-year-old woman with thymomatous MG who presented with pustules and left lower limb pain. Evaluation showed osteomyelitis of the pubic ramus and ileopsoas abscess. The second case was a 54-year-old man who presented in myasthenic crisis due to pulmonary nocardiosis. The third case was a 48-year-old man with thymomatous MG who presented with lung abscess. All of them recovered completely after treatment with co-trimoxazole. Analysis of the 21 patients identified four risk factors for nocardiosis in MG: elderly men; thymoma; immunosuppressant medication, mainly steroid therapy; and pre-existing lung disease. Lungs was the most common site of infection. Suppurative disease was common manifestation regardless of organ involved. Clinical course is not unfavourable.

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Lymphocutaneous spread of Mycobacterium elephantis in an immunocompetent individual: A case report

SAGE Open Medical Case Reports ◽

10.1177/2050313x211034913 ◽

2021 ◽

Vol 9 ◽

pp. 2050313X2110349

Author(s):

Brett D Edwards ◽

Ranjani Somayaji ◽

Dina Fisher ◽

Justin C Chia

Keyword(s):

Case Report ◽

Chronic Lung Disease ◽

Contaminated Soil ◽

Lung Abscess ◽

Immunocompetent Individual ◽

First Case ◽

Antimycobacterial Agents ◽

Vitro Data ◽

In Vitro Data

Mycobacterium elephantis was first described when isolated from an elephant that succumbed to lung abscess. However, despite this namesake, it is not associated with animals and has been described most often as a probable colonizer rather than pathogen in humans with chronic lung disease. In this report, we describe the first case of lymphocutaneous infection from M. elephantis, likely as a result of cutaneous inoculation with contaminated soil. This offers further evidence to its capabilities as a pathogen. We provide a review of the limited prior reports of M. elephantis and outline the available in vitro data on efficacy of various antimycobacterial agents.

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Myasthenia gravis in children: analysis of 18 patients

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2001000500005 ◽

2001 ◽

Vol 59 (3B) ◽

pp. 681-685 ◽

Cited By ~ 13

Author(s):

Maria da Penha A. Morita ◽

Alberto A. Gabbai ◽

Acary S.B. Oliveira ◽

Audrey S. Penn

Keyword(s):

Myasthenia Gravis ◽

Intravenous Immunoglobulin ◽

Acetylcholine Receptor ◽

Nerve Stimulation ◽

Chest Ct ◽

Clinical Severity ◽

Myasthenic Crisis ◽

Repetitive Nerve Stimulation ◽

Follicular Hyperplasia ◽

Receptor Antibodies

Myasthenia gravis (MG) in childhood is rare comprising 10 to 20 % of all myasthenic patients. We studied 18 patients with MG whose first symptoms started from 1 to 12 years of age, followed at the Department of Neurology of the UNIFESP-EPM, from January 1983 to August 1997. There were 10 girls and 8 boys (1.2:1). Eleven patients (61%) presented moderate or severe generalized disease and 4 (22%) had at least one myasthenic crisis. EMG with supramaximal repetitive nerve stimulation was diagnostic in 8 (47%) out of 17 patients, and chest CT was normal in 14 patients. Seropositivity to acetylcholine receptor antibodies was found in 81.6% (9 out of 11 tested) and the levels had no relation to clinical severity. Nine out of 16 patients (56%) worsened with pyridostigmine alone and were treated with prednisone. Four out of those nine continued worsening despite steroids and were subjected to thymectomy (all showed thymic lymphoid follicular hyperplasia). Three patients (75%) improved markedly after thymectomy and one (25%) worsened, eventually getting better with intravenous immunoglobulin and oral azathioprine. MG treatment, using all resources available, has to be individualized for each child.

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Emergence of myasthenia gravis in dengue infection—first case report

Journal of NeuroVirology ◽

10.1007/s13365-021-00950-8 ◽

2021 ◽

Vol 27 (1) ◽

pp. 183-185

Author(s):

Yue Hui Lau ◽

Suganthi Chinnasami

Keyword(s):

Case Report ◽

Myasthenia Gravis ◽

Dengue Infection ◽

First Case

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Delivering a shared library management system for Wales

Library Management ◽

10.1108/lm-04-2016-0032 ◽

2016 ◽

Vol 37 (6/7) ◽

pp. 385-395 ◽

Cited By ~ 2

Author(s):

Gareth Wyn Owen

Keyword(s):

Management System ◽

Review Of Literature ◽

Content Type ◽

Implementation Phase ◽

Library Management ◽

First Case ◽

Library Management System ◽

The Uk ◽

Practical Implications

Purpose A case study of the Wales Higher Education Libraries Forum (WHELF) project to procure and implement a shared library management system (LMS) for all universities in Wales, together with the National Health Service Libraries in Wales and the National Library of Wales. In particular, the purpose of this paper is to explore the drivers to this collaboration, outline the benefits achieved and the framework to realise further benefits. Design/methodology/approach Case study review of the process, together with a review of literature on consortia and LMSs. Findings WHELF has developed into a more mature consortium through procuring and implementing a shared LMS. The process has delivered tangible benefits and is driving more work to realise further benefits. Research limitations/implications As the WHELF Shared LMS project is only nearing the end of the implementation phase, many of the anticipated operational benefits cannot be reported. Practical implications Useful case study for other consortia or potential consortia. Originality/value WHELF is in vanguard of consortia developments in the UK, and this is the first case study of the project.

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Effective Early Treatment of AChR Antibody-Positive Myasthenia Gravis with Rituximab; the Experience from a Neuroimmunology Clinic in a Developing Country

Journal of Central Nervous System Disease ◽

10.1177/11795735211016080 ◽

2021 ◽

Vol 13 ◽

pp. 117957352110160

Author(s):

Thomas Mathew ◽

Kurian Thomas ◽

Saji K John ◽

Shruthi Venkatesh ◽

Raghunandan Nadig ◽

...

Keyword(s):

Observational Study ◽

Myasthenia Gravis ◽

Treatment Option ◽

Early Treatment ◽

Early Stage ◽

Tertiary Care ◽

Response To Treatment ◽

Myasthenic Crisis ◽

Achr Antibody ◽

Significant Difference

Background: Rituximab is reserved for treating refractory myasthenia gravis (MG) patients. Here we report our experience with rituximab in AChR antibody positive generalized MG (gMG) and impending myasthenic crisis (IMC). Methods: This retrospective, observational study, conducted at a tertiary care, neuroimmunology clinic, analyzed the data of patients with AChR antibody positive gMG, treated with rituximab between 1st January 2016 and 30th October 2018. Results: Eleven patients with AChR antibody positive gMG received rituximab. Mean age of the cohort was 50.54 ± 18.71 years with 9 males. Seven out of 11 patients received rituximab in the early stage (<2 years from onset) and had good response to treatment. Four of the 5 patients with IMC improved with rituximab alone. In the 10 patients who regularly followed up, there was a significant difference between the QMG scores at baseline and at 1, 2, 6, 12, and 18 months ( P < .0001). Conclusion: Rituximab appears to be a potentially effective early treatment option for AChR antibody positive generalized MG and impending myasthenic crisis.

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Post-thymectomy myasthenia gravis: a case report and systematic review of literature

BMJ Case Reports ◽

10.1136/bcr-2021-246005 ◽

2021 ◽

Vol 14 (12) ◽

pp. e246005

Author(s):

Louise Gurowich ◽

Gabriel Yiin ◽

Adam Maxwell ◽

Alexandra Rice

Keyword(s):

Systematic Review ◽

Case Report ◽

Myasthenia Gravis ◽

Early Onset ◽

Late Onset ◽

High Morbidity ◽

Review Of Literature ◽

Prompt Treatment ◽

Autoimmune Condition ◽

Anti Acetylcholine

Myasthenia gravis (MG) is an autoimmune condition affecting the neuromuscular junction characterised by weakness and fatiguability, carrying a high morbidity if treatment is delayed. A clear association with thymoma has led to management with thymectomy as a common practice, but MG presenting post-thymectomy has rarely been reported. We present a case of an 82- year-old woman developing fatigue, ptosis and dysarthria 3 months after thymectomy. After a clinical diagnosis of MG was made, she responded well to prompt treatment with prednisolone and pyridostigmine. Her anti-acetylcholine receptor antibody (anti-AChR) subsequently came back positive. Our systematic review reveals that post-thymectomy MG can be categorised as early-onset or late-onset form with differing aetiology, and demonstrated correlation between preoperative anti-AChR titres and post-thymectomy MG. The postulated mechanisms for post-thymectomy MG centre around long-lasting peripheral autoantibodies. Clinicians should actively look for MG symptoms in thymoma patients and measure anti-AChR preoperatively to aid prognostication.

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Plasmapheresis in the treatment of myasthenia gravis: retrospective study of 26 patients

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2004000300003 ◽

2004 ◽

Vol 62 (2b) ◽

pp. 391-395 ◽

Cited By ~ 9

Author(s):

Rosana Carandina-Maffeis ◽

Anamarli Nucci ◽

José F.C. Marques Jr ◽

Eduardo G. Roveri ◽

Beatriz H.M. Pfeilsticker ◽

...

Keyword(s):

Retrospective Study ◽

Side Effects ◽

Myasthenia Gravis ◽

Plasma Exchange ◽

Mortality Rates ◽

Motor Deficit ◽

Myasthenic Crisis ◽

Clinical Hospital ◽

The Mean ◽

Mean Time

We analyzed the experience of Unicamp Clinical Hospital with plasma exchange (PE) therapy in myasthenia gravis (MG). About 17.8 % of a totality of MG patients had PE performed: 26 cases, 19 women and seven men. The mean age-onset of MG was 28 years, extremes 11 and 69. Minimum deficit observed in the group was graded IIb (O & G) or IIIa (MGFA scale). One patient had prethymectomy PE. In seven the procedures were performed due to myasthenic crisis and in 18 patients due to severe myasthenic symptoms or exacerbation of previous motor deficit. Two patients were also submitted to chronic PE considering refractoriness to other treatments. Twenty-six patients had 44 cycles of PE and 171 sessions. The mean number of sessions was 3.9 (SD ± 1.4) each cycle; median 5, extremes 2 and 6. The mean time by session was 106,5 minutes (SD ± 35.2); median 100.5 (extremes of 55 and 215). The mean volume of plasma exchanged in each session was 2396 ml (SD ± 561); median 2225 (extremes 1512 and 4500). Side effects occurred: reversible hypotension (seven cases), mild tremor or paresthesias (seven cases). Infection and mortality rates due to PE were zero. All patients had immediate benefit of each PE cycle and usually they also received prednisone or other immunosuppressors. Good acceptance of the procedure was observed in 80.7% of patients.

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Breast necrosis induced by the use of coumadin: case report and review of literature

Einstein (São Paulo) ◽

10.1590/s1679-45082015rc2829 ◽

2015 ◽

Vol 13 (3) ◽

pp. 417-419 ◽

Cited By ~ 2

Author(s):

Dani Ejzenberg ◽

Lucienne Pereira Del Grossi Neusquen ◽

Daniel Lorber Rolnik ◽

Adriana Chebar Lozinsky ◽

José Roberto Morales Piato

Keyword(s):

Case Report ◽

Skin Necrosis ◽

Review Of Literature ◽

First Case

The coumadin-induced skin necrosis is rare and occurs more frequently in the breasts, thighs and buttocks. We describe the first case of coumadin necrosis of the breast in Brazil in a 62-year-old patient.

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