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Verma R, Chakraborty R, Tripathi P. Progressive Bulbar Palsy with Facial Diplegia and Proximal Weakness Diagnosed as Juvenile-Onset Myasthenia Gravis. Ann Indian Acad Neurol 2023; 26:589-591. [PMID: 37970251 PMCID: PMC10645248 DOI: 10.4103/aian.aian_128_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/08/2023] [Accepted: 04/11/2023] [Indexed: 11/17/2023] Open
Affiliation(s)
- Rajesh Verma
- Department of Neurology, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Rajarshi Chakraborty
- Department of Neurology, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Pooja Tripathi
- Department of Neurology, King George’s Medical University, Lucknow, Uttar Pradesh, India
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2
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Kosaka T, Nakahashi H, Nakazawa S, Ibe T, Yajima T, Shirabe K. Taste disorder in a patient with invasive thymoma without myasthenia gravis: a rare case report. MEDIASTINUM (HONG KONG, CHINA) 2022; 6:9. [PMID: 35340830 PMCID: PMC8841547 DOI: 10.21037/med-21-28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/15/2021] [Indexed: 06/14/2023]
Abstract
Taste disorder has been reported as a non-motor symptom caused by myasthenia gravis (MG)-related autoimmune mechanism. Taste disorder in some cases recovered along with MG treatment, such as thymothymectomy or immunosuppressive treatment. However, symptom of taste disorder in thymoma patients without MG is very rare. Here, we reported a case of invasive thymoma without MG which had concurrent taste disorder. The taste disorder was successfully treated with cyclosporine. A female in her seventies had an anterior mediastinal tumor of 78-mm in diameter and pleural dissemination. She also had taste disorder, limited to sweet taste, and pure red cell aplasia (PRCA). Symptoms and physical findings showed no feature of MG. Pre-operative blood examination revealed no elevation of anti-acetylcholine receptor antibody . Extended total thymothymectomy and resection of all detectable pleural disseminations was performed. Pathological examination showed type B3 thymoma. Clinical stage was Masaoka stage IVa. After operation, there was no improvement in taste disorder and PRCA. Six months after operation, cyclosporine was administered for PRCA. In parallel with gradual improvement of anemia, taste disorder also gradually improved. Three months after the first administration of cyclosporine, taste disorder had completely recovered. This is the first case of taste disorder without any myasthenic status, which recovered with immunosuppressive drug. Our case suggested the potency of immunosuppressive treatment for taste disorder associate with thymoma without MG.
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Affiliation(s)
- Takayuki Kosaka
- Department of Thoracic Surgery, National Hospital Organization Takasaki General Medical Center, Takasaki, Japan
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
| | | | - Seshiru Nakazawa
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Takashi Ibe
- Department of Thoracic Surgery, National Hospital Organization Takasaki General Medical Center, Takasaki, Japan
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Toshiki Yajima
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Ken Shirabe
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
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Sanghi P, Bremner F. An unusual presentation of thymoma: dysgeusia, ulcerative colitis, keratoconjunctivitis sicca, autoimmune retinopathy and myasthenia gravis. BMJ Case Rep 2022; 15:e246861. [PMID: 35027385 PMCID: PMC8762128 DOI: 10.1136/bcr-2021-246861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2021] [Indexed: 11/03/2022] Open
Abstract
A 41-year-old female presented with dysgeusia, dry eyes, nyctalopia with progressive visual field constriction (due to autoimmune retinopathy) and gastrointestinal symptoms (due to ulcerative colitis). She was subsequently admitted to intensive care with a myasthenic crisis, and CT of the thorax demonstrated a thymoma.Following thymectomy and adjuvant radiotherapy, she has remained in complete remission from her ulcerative colitis and myasthenia gravis, her retinopathy has stabilised and there has been no thymoma recurrence over a 10-year postoperative period. There was a brief relapse of her dysgeusia (causing weight loss) and dry eye symptoms 3 years after her surgery, which resolved 8 months later. While the association of thymomas with paraneoplastic syndromes (PNS) is well established, it is unusual to present with multiple PNS, and some of these have only been documented in sparse case reports to date. Thymectomy played a crucial role in improvement and stabilisation of her PNS.
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Affiliation(s)
- Priyanka Sanghi
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Department of Neuro-Ophthalmology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Fion Bremner
- Department of Neuro-Ophthalmology, National Hospital for Neurology and Neurosurgery, London, UK
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Thomas DC, Chablani D, Parekh S, Pichammal RC, Shanmugasundaram K, Pitchumani PK. Dysgeusia: A review in the context of COVID-19. J Am Dent Assoc 2021; 153:251-264. [PMID: 34799014 PMCID: PMC8595926 DOI: 10.1016/j.adaj.2021.08.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 08/07/2021] [Accepted: 08/20/2021] [Indexed: 12/19/2022]
Abstract
Background Taste disorders in general, and dysgeusia in particular, are relatively common disorders that may be a sign of a more complex acute or chronic medical condition. During the COVID-19 pandemic, taste disorders have found their way into the realm of general as well as specialty dentistry, with significance in screening for patients who potentially may have the virus. Types of Studies Reviewed The authors searched electronic databases (PubMed, Embase, Web of Science, Google Scholar) for studies focused on dysgeusia, ageusia, and other taste disorders and their relationship to local and systemic causes. Results The authors found pertinent literature explaining the normal physiology of taste sensation, proposals for suggested new tastes, presence of gustatory receptors in remote tissues of the body, and etiology and pathophysiology of taste disorders, in addition to the valuable knowledge gained about gustatory disorders in the context of COVID-19. Along with olfactory disorders, taste disorders are one of the earliest suggestive symptoms of COVID-19 infection. Conclusions Gustatory disorders are the result of local or systemic etiology or both. Newer taste sensations, such as calcium and fat tastes, have been discovered, as well as taste receptors that are remote from the oropharyngeal area. Literature published during the COVID-19 pandemic to date reinforces the significance of early detection of potential patients with COVID-19 by means of screening for recent-onset taste disorders. Practical Implications Timely screening and identification of potential gustatory disorders are paramount for the dental care practitioner to aid in the early diagnosis of COVID-19 and other serious systemic disorders.
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Gaspar P, Bessa F, Antunes Meireles P, Parreira I, Mota C. Sweet Taste Dysgeusia in a Patient with Indapamide-Related Hyponatremia: Case Report and Review of the Literature. Cureus 2021; 13:e13079. [PMID: 33680619 PMCID: PMC7931776 DOI: 10.7759/cureus.13079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Sweet taste dysgeusia is a rare symptom where patients experience all food as having a sweet taste. While its cause is still unknown, it has been increasingly reported in the setting of lung cancer and syndrome of inappropriate secretion of antidiuretic hormone-related hyponatremia. In this case report, we present what we believe to be the first case of sweet taste dysgeusia in a non-cancer context. We will briefly review and summarize all published cases describing this symptom and also reflect upon the nature of this condition focusing on the role of serum sodium levels in sweet taste receptor modulation.
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Affiliation(s)
- Pedro Gaspar
- Internal Medicine, Serviço de Medicina 2, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisboa, PRT.,Internal Medicine, Faculdade de Medicina, Universidade de Lisboa, Lisboa, PRT
| | - Filipe Bessa
- Internal Medicine, Serviço de Medicina 2, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisboa, PRT.,Internal Medicine, Faculdade de Medicina, Universidade de Lisboa, Lisboa, PRT
| | - Pedro Antunes Meireles
- Oncology, Serviço de Oncologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, PRT.,Oncology, Serviço de Medicina 2, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisboa, PRT
| | - Inês Parreira
- Internal Medicine, Serviço de Medicina 2, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisboa, PRT
| | - Catarina Mota
- Internal Medicine, Serviço de Medicina 2, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisboa, PRT.,Internal Medicine, Faculdade de Medicina, Universidade de Lisboa, Lisboa, PRT
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Zhu K, Chen J, Li J, Wang H, Huang X, Li Y, Feng H. Myasthenia Gravis With Thymoma, Manifesting as AChR-Ab-Positive, Distinct Bulbar Palsy Accompanied by Dysgeusia: A Case Series and Review of Literature. Front Neurol 2018; 9:214. [PMID: 29670572 PMCID: PMC5893777 DOI: 10.3389/fneur.2018.00214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 03/20/2018] [Indexed: 01/02/2023] Open
Abstract
In this review, we summarized three cases of myasthenia gravis (MG) with taste disorder and describe their clinical features in detail. Three MG patients presented with significant bulbar palsy symptoms, high AChR-Ab titers, and negative MuSK-Ab, were diagnosed with thymoma. Furthermore, we observed that dysgeusia could manifest earlier than the occurrence of typical MG symptoms, even predict a MG relapse or a myasthenic crisis in the course of MG. We believe that dysgeusia is a non-motor symptom of MG, which especially exists in MG patients with thymoma and serious bulbar palsy. Therefore, being alert to this symptom may facilitate the early diagnosis of MG and judge the progress of the disease.
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Affiliation(s)
- Kai Zhu
- Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Disease, Guangzhou, China
| | - Jiaxin Chen
- Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Disease, Guangzhou, China
| | - Jingjing Li
- Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Disease, Guangzhou, China
| | - Haiyan Wang
- Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Disease, Guangzhou, China
| | - Xin Huang
- Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Disease, Guangzhou, China
| | - Yan Li
- Department of Neurosurgical Intensive Care Unit, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, China
| | - Huiyu Feng
- Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Disease, Guangzhou, China
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Correlation of HLA-DQ and TNF-α gene polymorphisms with ocular myasthenia gravis combined with thyroid-associated ophthalmopathy. Biosci Rep 2017; 37:BSR20160440. [PMID: 28119492 PMCID: PMC5469324 DOI: 10.1042/bsr20160440] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 01/22/2017] [Accepted: 01/24/2017] [Indexed: 02/07/2023] Open
Abstract
The present study aims to explore the correlation of human leucocyte antigen (HLA)-DQ and tumour necrosis factor (TNF)-α gene polymorphisms with ocular myasthenia gravis (OMG) combined with thyroid-associated ophthalmopathy (TAO). From March 2009 to March 2015, 56 OMG patients complicated with TAO (OMG + TAO group), 134 patients diagnosed with OMG only (OMG group) and 236 healthy individuals (control group) were enrolled in the present study. PCR-sequence specific primer (PCR-SSP) was used for HLA-DQ genotyping and PCR-restriction fragment length polymorphism (PCR-RFLP) for TNF-α genotyping. ELISA kit was applied to detect acetylcholine receptor antibody (AchRAb) level and chemiluminescence immunoassay (CLIA) to measure thyroid-associated antibody (T-Ab) level. Logistic regression analysis was carried out to analyse the risk factors for OMG combined with TAO. DQA1*0103 showed lower frequency in the OMG group than in the control group. DQA1*0301 showed increased and DQB1*0601 showed decreased frequency in the OMG + TAO group. DQB1*0501 showed higher frequency in the OMG and OMG + TAO groups than in the control group. Patients carrying TNF-α -863C > A (CA + AA) might confront with greater risks of OMG combined with TAO. Frequency of DQA1*0103/*0301 and DQB1*0501/*0601, and TNF-α -863C > A, -238G > A and -308G > A were associated with the levels of AchRAb and T-Ab. TNF-α -863C > A (CA + AA) and high level of T-Ab were risk factors for OMG combined with TAO. Our results demonstrate that TNF-α -863 polymorphism is possibly correlated with the risk of OMG combined with TAO.
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Leon-Sarmiento FE, Leon-Ariza JS, Prada D, Leon-Ariza DS, Rizzo-Sierra CV. Sensory aspects in myasthenia gravis: A translational approach. J Neurol Sci 2016; 368:379-88. [DOI: 10.1016/j.jns.2016.07.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 07/07/2016] [Accepted: 07/08/2016] [Indexed: 12/24/2022]
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Osada O, Iwasaki A, Nakahashi H, Kim Y, Kaneko K. [A case of myasthenia gravis with transient taste disorders followed by aplastic anemia after thymectomy]. Rinsho Shinkeigaku 2016; 56:200-3. [PMID: 26876109 DOI: 10.5692/clinicalneurol.cn-000792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 45-year-old man was admitted to our hospital because of taste disorders in March 2014. He exhibited cervical muscle weakness and left eye ptosis, which responded to Tensilon test, and was diagnosed with myasthenia gravis (MG). He developed aspiration pneumonia and myasthenic crisis, which was treated with intravenous immunoglobulin and steroid pulse therapy. All symptoms disappeared. Oral administration of prednisolone and tacrolimus was started. Chest CT revealed thymoma and extended thymectomy was performed in May 2014. In December 2014, seven months after the thymectomy, hematological examination showed pancytopenia including severe neutropenia. We diagnosed his illness as aplastic anemia (AA). Cyclosporine therapy with transfusion was administerd and led to reticulocyte count recovery. Since May 2015, hemoglobin recovery reached a blood transfusion free period. To our knowledge, this is the first case report with the patient supposed of relationship among taste disorders, AA and thymoma-associated MG.
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Affiliation(s)
- Osamu Osada
- Department of Neurology, Fukaya Red Cross Hospital
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Leon-Sarmiento FE, Leon-Ariza JS, Prada DG, Leon-Ariza DS. Chemosensory disturbances-associated nanocholinergic dysfunction: The case of, not only, myasthenia gravis. J Neurol Sci 2015; 356:5-6. [PMID: 26139340 DOI: 10.1016/j.jns.2015.06.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 06/24/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Fidias E Leon-Sarmiento
- Smell & Taste Center, Department of Otorhinolaryngology, Perelman School of Medicine, Philadelphia, PA, USA.
| | - Juan S Leon-Ariza
- Mediciencias Research Group, Unicolciencias/Universidad Nacional, Bogota, Colombia; Visiting Scholar, Department of Radiology, Perelman School of Medicine, Philadelphia, PA, USA
| | - Diddier G Prada
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Daniel S Leon-Ariza
- Mediciencias Research Group, Unicolciencias/Universidad Nacional, Bogota, Colombia; Faculty of Health Sciences, UDES, Bucaramanga, Colombia
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Jones SM, Gwathmey KG, Burns TM. Quality of life measures for myasthenia gravis and evaluation of non-motor symptoms. ACTA ACUST UNITED AC 2015. [DOI: 10.1111/cen3.12174] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Sarah M. Jones
- Department of Neurology; University of Virginia; Charlottesville Virginia USA
| | - Kelly G. Gwathmey
- Department of Neurology; University of Virginia; Charlottesville Virginia USA
| | - Ted M. Burns
- Department of Neurology; University of Virginia; Charlottesville Virginia USA
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