1
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El Fakih R, Bajuaifer YS, Shah AY, Sulaiman R, Almohamady R, ELGohary G, Alothaimeen HS, Aljurf M. Paraneoplastic syndromes associated with classic Hodgkin lymphoma, a systematic literature review. Ann Hematol 2024; 103:1131-1137. [PMID: 37428199 DOI: 10.1007/s00277-023-05357-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 07/04/2023] [Indexed: 07/11/2023]
Abstract
PNS are uncommon manifestations of cancer. The current literature about these syndromes in the setting of cHL is disintegrated. A systematic literature review of all published literature was conducted. One hundred twenty-eight patients from 115 publications met the inclusion/exclusion criteria. Eight-five patients were of the NS subtype (66.4%). The most frequent clinical presentation of the PNS was CNS manifestation (25.8%). The majority of patients were diagnosed with the cHL and PNS simultaneously (42.2%). In 33.6% of patients, the lymphoma diagnosis preceded the PNS diagnosis. In 16.4% of patients, the PNS diagnosis preceded the lymphoma diagnosis. The presence of PNS antibodies was reported in 35 patients (27.3%). Age older than 18 was associated with higher prevalence of PNS. The CR rate of the lymphoma was 77.3%. The complete resolution rate of the PNS was 54.7%. Relapse of lymphoma was reported in 13 patients, and recurrence of the PNS upon relapse was reported in 10/13 patients.
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Affiliation(s)
- Riad El Fakih
- Oncology Center, King Faisal Specialist Hospital and Research Centre, PO Box 3354, Riyadh, 11471, Saudi Arabia.
| | - Yazeed S Bajuaifer
- Oncology Center, King Faisal Specialist Hospital and Research Centre, PO Box 3354, Riyadh, 11471, Saudi Arabia
| | - Amna Yousaf Shah
- Oncology Center, King Faisal Specialist Hospital and Research Centre, PO Box 3354, Riyadh, 11471, Saudi Arabia
| | - Reem Sulaiman
- Oncology Center, King Faisal Specialist Hospital and Research Centre, PO Box 3354, Riyadh, 11471, Saudi Arabia
| | - Rawan Almohamady
- Oncology Center, King Faisal Specialist Hospital and Research Centre, PO Box 3354, Riyadh, 11471, Saudi Arabia
| | - Ghada ELGohary
- Oncology Center, King Faisal Specialist Hospital and Research Centre, PO Box 3354, Riyadh, 11471, Saudi Arabia
- Oncology Center, University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Haya S Alothaimeen
- Oncology Center, King Faisal Specialist Hospital and Research Centre, PO Box 3354, Riyadh, 11471, Saudi Arabia
| | - Mahmoud Aljurf
- Oncology Center, King Faisal Specialist Hospital and Research Centre, PO Box 3354, Riyadh, 11471, Saudi Arabia
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2
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Li X, Gaibor C, Fesler M. Killing Two Birds With One Stone: Successful Management With Rituximab in the Coexistence of Myasthenia Gravis and Marginal Zone Lymphoma. Cureus 2023; 15:e45877. [PMID: 37885504 PMCID: PMC10598348 DOI: 10.7759/cureus.45877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2023] [Indexed: 10/28/2023] Open
Abstract
Myasthenia gravis (MG) is an autoimmune neuromuscular disorder characterized by motor weakness affecting various muscle groups. The simultaneous or sequential occurrence of lymphoma and MG, often seen in patients, could be influenced by common genetic and biological factors that drive unregulated lymphocyte growth, leading to autoimmunity and lymphoma. This case report describes a 72-year-old male with coexisting marginal zone lymphoma and MG, who exhibited a positive response to rituximab treatment intended for the lymphoma, but surprisingly effective for both conditions. The patient experienced significant improvement in MG symptoms and a decline in serum anti-acetylcholine receptor (AChR) antibodies, along with achieving hematologic remission in the lymphoma. These observations emphasize the potential therapeutic advantages of rituximab in treating cases with concurrent MG and lymphoma, providing useful insights for future research and multifaceted clinical management.
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Affiliation(s)
- Xiao Li
- Internal Medicine, St. Luke's Hospital, Chesterfield, USA
| | - Carlos Gaibor
- Internal Medicine, St. Luke's Hospital, Chesterfield, USA
| | - Mark Fesler
- Hematology and Oncology, St. Luke's Hospital, Chesterfield, USA
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3
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Ingelfinger F, Kramer M, Lutz M, Widmer CC, Piccoli L, Kreutmair S, Wertheimer T, Woodhall M, Waters P, Sallusto F, Lanzavecchia A, Mundt S, Becher B, Schreiner B. Antibodies Produced by CLL Phenotype B Cells in Patients With Myasthenia Gravis Are Not Directed Against Neuromuscular Endplates. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2023; 10:10/2/e200087. [PMID: 36754834 PMCID: PMC9909583 DOI: 10.1212/nxi.0000000000200087] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 11/28/2022] [Indexed: 02/10/2023]
Abstract
BACKGROUND AND OBJECTIVES Myasthenia gravis (MG) can in rare cases be an autoimmune phenomenon associated with hematologic malignancies such as chronic lymphocytic leukemia (CLL). It is unclear whether in patients with MG and CLL, the leukemic B cells are the ones directly driving the autoimmune response against neuromuscular endplates. METHODS We identified patients with acetylcholine receptor antibody-positive (AChR+) MG and CLL or monoclonal B-cell lymphocytosis (MBL), a precursor to CLL, and described their clinical features, including treatment responses. We generated recombinant monoclonal antibodies (mAbs) corresponding to the B-cell receptors of the CLL phenotype B cells and screened them for autoantigen binding. RESULTS A computational immune cell screen revealed a subgroup of 5/38 patients with MG and 0/21 healthy controls who displayed a CLL-like B-cell phenotype. In follow-up hematologic flow cytometry, 2 of these 5 patients were diagnosed with an MBL. An additional patient with AChR+ MG as a complication of manifest CLL presented at our neuromuscular clinic and was successfully treated with the anti-CD20 therapy obinutuzumab plus chlorambucil. We investigated the specificities of expanding CLL-like B-cell clones to assess a direct causal link between the 2 diseases. However, we observed no reactivity of the clones against the AChR, antigens at the neuromuscular junction, or other common autoantigens. DISCUSSION Our study suggests that AChR autoantibodies are produced by nonmalignant, polyclonal B cells The new anti-CD20 treatment obinutuzumab might be considered in effectively treating AChR+ MG. CLASSIFICATION OF EVIDENCE This is a single case study and provides Class IV evidence that obinutuzumab is safe to use in patients with MG.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Burkhard Becher
- From the Institute of Experimental Immunology (F.I., M.L., S.K., T.W., S.M., B.S., B.B.), University of Zurich, Switzerland; Department of Neurology (F.I., B.S.), University Hospital Zurich, Switzerland; Institute for Research in Biomedicine (M.K., L.P., F.S., A.L.), Università Della Svizzera Italiana, Bellinzona, Switzerland; Institute of Microbiology (M.K., F.S.), ETH Zurich, Switzerland; Department of Medical Oncology and Hematology (C.C.W.), University Hospital Zurich and University of Zurich, Switzerland; and Nuffield Department of Clinical Neurosciences (M.W., P.W.), University of Oxford, United Kingdom.
| | - Bettina Schreiner
- From the Institute of Experimental Immunology (F.I., M.L., S.K., T.W., S.M., B.S., B.B.), University of Zurich, Switzerland; Department of Neurology (F.I., B.S.), University Hospital Zurich, Switzerland; Institute for Research in Biomedicine (M.K., L.P., F.S., A.L.), Università Della Svizzera Italiana, Bellinzona, Switzerland; Institute of Microbiology (M.K., F.S.), ETH Zurich, Switzerland; Department of Medical Oncology and Hematology (C.C.W.), University Hospital Zurich and University of Zurich, Switzerland; and Nuffield Department of Clinical Neurosciences (M.W., P.W.), University of Oxford, United Kingdom.
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4
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Alhaidar MK, Abumurad S, Soliven B, Rezania K. Current Treatment of Myasthenia Gravis. J Clin Med 2022; 11:jcm11061597. [PMID: 35329925 PMCID: PMC8950430 DOI: 10.3390/jcm11061597] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 02/04/2023] Open
Abstract
Myasthenia gravis (MG) is the most extensively studied antibody-mediated disease in humans. Substantial progress has been made in the treatment of MG in the last century, resulting in a change of its natural course from a disease with poor prognosis with a high mortality rate in the early 20th century to a treatable condition with a large proportion of patients attaining very good disease control. This review summarizes the current treatment options for MG, including non-immunosuppressive and immunosuppressive treatments, as well as thymectomy and targeted immunomodulatory drugs.
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5
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Willis C, Williamson M, Constantinou N, Johns E. Myasthenia gravis associated with a pelvic follicular lymphoma. BMJ Case Rep 2022; 15:e248011. [PMID: 35027392 PMCID: PMC8762130 DOI: 10.1136/bcr-2021-248011] [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: 12/20/2021] [Indexed: 11/04/2022] Open
Abstract
An 81-year-old woman presented with neck weakness, dysarthria, dysphasia and left-sided ptosis. Myasthenia gravis (MG) was strongly suspected. Voltage gated calcium channel (VGCC) antibodies, associated with Lambert-Eaton myasthenic syndrome (LEMS), were negative. Acetylcholine receptor (AChR) antibody level was 536 nmol/L and diagnosis of MG was confirmed. Imaging revealed a pelvic mass and subsequent biopsy confirmed a pelvic follicular lymphoma. Our searches revealed this to be the first documented case of MG associated with a pelvic follicular lymphoma. She underwent radiotherapy to treat the lymphoma and received both pyridostigmine and immunosuppression to treat the MG. Her AChR antibody level decreased to 38 nmol/L and her MG symptoms resolved aside from head drop which is continuing to improve. Her lymphoma is now in remission. We have presented a case with a successful outcome, which highlights the importance of screening for lymphoma and thymoma in new presentations of MG.
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Affiliation(s)
- Charlotte Willis
- Gastroenterology Department, Stoke Mandeville Hospital, Aylesbury, UK
- Radcliffe Department of Medicine, University of Oxford Medical Sciences Division, Oxford, Oxfordshire, UK
| | - Max Williamson
- Radcliffe Department of Medicine, University of Oxford Medical Sciences Division, Oxford, Oxfordshire, UK
| | | | - Emily Johns
- Gastroenterology Department, Stoke Mandeville Hospital, Aylesbury, UK
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6
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Zha K, Silvestri NJ. Iatrogenic immunodeficiency-associated lymphoproliferative disorder secondary to mycophenolate mofetil treatment in a patient with myasthenia gravis. Muscle Nerve 2022; 65:E14-E16. [PMID: 34993978 DOI: 10.1002/mus.27485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/29/2021] [Accepted: 12/31/2021] [Indexed: 11/12/2022]
Affiliation(s)
- Kate Zha
- University at Buffalo Jacobs School of Medicine & Biomedical Sciences, Buffalo, New York, USA
| | - Nicholas J Silvestri
- Department of Neurology, University at Buffalo Jacobs School of Medicine & Biomedical Sciences, Buffalo, New York, USA
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7
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Acquired Angioedema Due to C1 inhibitor Deficiency Caused by Non-Hodgkin Lymphoma in a Patient with Myasthenia Gravis. REV ROMANA MED LAB 2021. [DOI: 10.2478/rrlm-2021-0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
Acquired angioedema due to C1-inhibitor deficiency is a very rare disorder that usually appears in patients with lymphoproliferative and/or autoimmune diseases. This type of swelling is bradykinin mediated and does not respond to antihistamines, corticosteroids, or epinephrine. The symptoms usually appear in patients older than 40 years with recurrent episodes of angioedema without wheals. The family history is negative. The swelling could affect any tissue, but most frequently is located at the face, lips, tongue, larynx, or extremities. In the gastrointestinal tract, it causes pain, nausea, vomiting, and diarrhea. The upper respiratory airway oedema is a potentially life-threatening condition due to asphyxiation. The oedema attacks may precede the symptoms of the causative disease for months or years. In most cases, the treatment of the underlying disease resolves the angioedema episodes. Here we report a case of C1-INH-AAE caused by non-Hodgkin lymphoma in a patient diagnosed many years before with myasthenia gravis whose angioedema symptoms resolved after the specific treatment of lymphoma.
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8
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Patil M, Muppidi V, Meegada S, Dowell KT, Bowers JD. Guillain-Barre Syndrome and Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Secretion as Paraneoplastic Syndromes in Splenic Marginal B-cell Non-Hodgkins Lymphoma: A Rare Presentation. Cureus 2020; 12:e10133. [PMID: 32879838 PMCID: PMC7456633 DOI: 10.7759/cureus.10133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Splenic marginal zone lymphoma (SMZL), a rare sub-type of non-Hodgkin lymphoma (NHL) presents with abdominal discomfort, lymphocytosis, cytopenias along with B symptoms including fatigue, night sweats, night fevers, weight loss. NHLs rarely present with paraneoplastic neurological syndromes like Guillain-Barre (GB) syndrome, myelopathy causing paraplegia, chorea, neuromyotonia, vasculitic neuropathy and dermatomyositis. Here, we present a 85-year old caucasian lady presenting with GB syndrome and Syndrome of Inappropriate Antidiuretic Hormone (SIADH) who eventually got diagnosed with SMZL.
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Affiliation(s)
- Madhuri Patil
- Internal Medicine, CHRISTUS Good Shepherd Medical Center, Longview, USA
| | | | - Sreenath Meegada
- Internal Medicine, University of Texas Health Science Center/Christus Good Shepherd Medical Center, Longview, USA
| | - Keanan T Dowell
- Internal Medicine, CHRISTUS Good Shepherd Medical Center, Longview, USA
| | - Joe D Bowers
- Neurology, CHRISTUS Good Shepherd Medical Center, Longview, USA
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9
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Rutar Gorišek V, Zupančič D, Zidar J, Horvat Ledinek A. Diffuse large B cell lymphoma mimics myasthenia gravis. Neurol Sci 2019; 41:727-728. [PMID: 31583556 DOI: 10.1007/s10072-019-04074-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 09/09/2019] [Indexed: 11/27/2022]
Affiliation(s)
| | - David Zupančič
- Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Janez Zidar
- Clinical Institute of Clinical Electrophysiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
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10
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Priola AM, Gned D, Veltri A, Priola SM. Case 261: Thymoma Embedded in Thymus with Pleural Implant in Myasthenia Gravis Lambert-Eaton Overlap Syndrome. Radiology 2018; 290:264-269. [PMID: 30571477 DOI: 10.1148/radiol.2018161761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
History A 29-year-old woman presented with a 6-month history of progressive general fatigue, fluctuating limb weakness, and difficulty climbing stairs. She initially experienced occasional episodes of transient diplopia that developed while reading in the evening. She subsequently started to experience dry eyes and mouth, difficulty chewing, and mild dysphagia that worsened throughout the day. Her medical history included hypothyroidism from Hashimoto thyroiditis and pneumonia with left pleural effusion. She had no smoking history, and her body mass index was normal (23.8 kg/m2). No medication use was reported at admission. Physical examination revealed mild bilateral ptosis, reduced muscle tone and strength that worsened in proximal leg muscles, and decreased deep tendon reflexes. An edrophonium test revealed improvement in muscle strength and eyelid ptosis. Repetitive nerve stimulation revealed low amplitude of compound muscle action potential at rest (0.21 mV), with a marked increase (700%; normal increase, <60%) at high-rate stimulation (50 Hz). Laboratory work-up was unremarkable except for detection of acetylcholine receptor antibodies in the serum (21.30 nmol/L) and P/Q-type voltage-gated calcium channel antibodies (220 pmol/L). Recent MRI of the brain and spine at an outside hospital showed no abnormal findings. At admission, the patient underwent CT of the chest, abdomen, and pelvis followed by thoracic MRI to further evaluate CT findings.
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Affiliation(s)
- Adriano M Priola
- From the Department of Diagnostic Imaging, San Luigi Gonzaga Hospital, University of Torino, Regione Gonzole 10, Orbassano 10043 (Torino), Italy
| | - Dario Gned
- From the Department of Diagnostic Imaging, San Luigi Gonzaga Hospital, University of Torino, Regione Gonzole 10, Orbassano 10043 (Torino), Italy
| | - Andrea Veltri
- From the Department of Diagnostic Imaging, San Luigi Gonzaga Hospital, University of Torino, Regione Gonzole 10, Orbassano 10043 (Torino), Italy
| | - Sandro M Priola
- From the Department of Diagnostic Imaging, San Luigi Gonzaga Hospital, University of Torino, Regione Gonzole 10, Orbassano 10043 (Torino), Italy
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11
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Nanni L, Broccoli A, Nanni C, Argnani L, Cavo M, Zinzani PL. Hodgkin lymphoma presenting with paraneoplastic myasthenia: a case report. Leuk Lymphoma 2018; 59:2990-2993. [PMID: 29616869 DOI: 10.1080/10428194.2018.1443336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Laura Nanni
- a Institute of Hematology "L. e A. Seràgnoli", University of Bologna , Bologna , Italy
| | - Alessandro Broccoli
- a Institute of Hematology "L. e A. Seràgnoli", University of Bologna , Bologna , Italy
| | - Cristina Nanni
- b Policlinico S.Orsola-Malpighi, UO Nuclear Medicine , Bologna , Italy
| | - Lisa Argnani
- a Institute of Hematology "L. e A. Seràgnoli", University of Bologna , Bologna , Italy
| | - Michele Cavo
- a Institute of Hematology "L. e A. Seràgnoli", University of Bologna , Bologna , Italy
| | - Pier Luigi Zinzani
- a Institute of Hematology "L. e A. Seràgnoli", University of Bologna , Bologna , Italy
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12
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Russell A, Yaraskavitch M, Fok D, Chhibber S, Street L, Korngut L. Obinutuzumab Plus Chlorambucil in a Patient with Severe Myasthenia Gravis and Chronic Lymphocytic Leukemia. J Neuromuscul Dis 2017; 4:251-257. [DOI: 10.3233/jnd-170211] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Angela Russell
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Megan Yaraskavitch
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Daniel Fok
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Sameer Chhibber
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Lesley Street
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Lawrence Korngut
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
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13
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Grignano E, Mekinian A, Jachiet V, Coppo P, Fain O. Manifestations auto-immunes et inflammatoires des hémopathies lymphoïdes. Rev Med Interne 2017; 38:374-382. [DOI: 10.1016/j.revmed.2016.10.396] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 10/03/2016] [Accepted: 10/27/2016] [Indexed: 10/20/2022]
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14
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Tandan R, Hehir MK, Waheed W, Howard DB. Rituximab treatment of myasthenia gravis: A systematic review. Muscle Nerve 2017; 56:185-196. [DOI: 10.1002/mus.25597] [Citation(s) in RCA: 157] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2017] [Indexed: 01/08/2023]
Affiliation(s)
- Rup Tandan
- Department of Neurological Sciences; University of Vermont, Robert Larner College of Medicine and University of Vermont Medical Center; Room 426, Health Sciences Research Facility, 149 Beaumont Avenue Burlington Vermont 05405 USA
| | - Michael K. Hehir
- Department of Neurological Sciences; University of Vermont, Robert Larner College of Medicine and University of Vermont Medical Center; Room 426, Health Sciences Research Facility, 149 Beaumont Avenue Burlington Vermont 05405 USA
| | - Waqar Waheed
- Department of Neurological Sciences; University of Vermont, Robert Larner College of Medicine and University of Vermont Medical Center; Room 426, Health Sciences Research Facility, 149 Beaumont Avenue Burlington Vermont 05405 USA
| | - Diantha B. Howard
- Center for Clinical and Translational Science; University of Vermont, Robert Larner College of Medicine and University of Vermont Medical Center; Burlington Vermont USA
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15
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Autoimmune Manifestations in Patients With Waldenström Macroglobulinemia. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2014; 14:456-9. [DOI: 10.1016/j.clml.2014.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 12/31/2013] [Accepted: 04/30/2014] [Indexed: 12/25/2022]
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16
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Roche J, Capablo J, Ara J. Miastenia gravis y asociación con neoplasias extratímicas. Neurologia 2014; 29:507-9. [DOI: 10.1016/j.nrl.2013.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 04/18/2013] [Accepted: 04/28/2013] [Indexed: 02/04/2023] Open
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17
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Roche J, Capablo J, Ara J. Myasthenia gravis in association with extrathymic neoplasia. NEUROLOGÍA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.nrleng.2013.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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18
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Ahmed ME, Mahgoub MA, Alnedar MG, Mahadi SI, Alzubeir M, El Hassan LA, Elamin EM, El Hassan AM. Myasthenic Crisis Manifesting as Postoperative Respiratory Failure following Resection of Unsuspected Intrathoracic Thymic T-Cell Lymphoma during Thyroidectomy for an Adjacent Large Retrosternal Goiter. Eur Thyroid J 2014; 3:206-10. [PMID: 25538904 PMCID: PMC4224263 DOI: 10.1159/000364822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 05/26/2014] [Indexed: 11/22/2022] Open
Abstract
A middle-aged female with a goiter of 10 years' duration presented with progressive pressure symptoms, nocturnal choking and dyspnea on exertion for 5 months. Physical examination demonstrated a large simple multinodular goiter. Imaging revealed a deep retrosternal goiter extending below the tracheal bifurcation with marked tracheal deviation. Total thyroidectomy was carried out via a cervical approach and a median sternotomy. Extubation was not possible, and the patient had to be kept intubated. She then went into a myasthenic crisis. Initial ventilatory support was followed by intravenous immunoglobulin, steroids and pyridostigmine. The patient had complete remission and was asymptomatic 18 months later. Histopathology showed a T-cell-rich thymoma in addition to a nodular colloid goiter.
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Affiliation(s)
- Mohamed E Ahmed
- Khartoum Teaching Hospital, Khartoum, Sudan
- Department of Medicine, Khartoum, Sudan
| | | | | | - Seif I Mahadi
- Khartoum Teaching Hospital, Khartoum, Sudan
- Department of Medicine, Khartoum, Sudan
| | - Maha Alzubeir
- Department of Surgery, Faculty of Medicine, at, Khartoum, Sudan
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19
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Hermans MAW, Stelten BML, Haak HR, de Herder WW, Dercksen MW. Two patients with a neuroendocrine tumour of the small intestine and paraneoplastic myasthenia gravis. Endocrinol Diabetes Metab Case Rep 2014; 2014:140013. [PMID: 24839548 PMCID: PMC4023180 DOI: 10.1530/edm-14-0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 04/25/2014] [Indexed: 11/20/2022] Open
Abstract
This paper reports on two patients with a long-standing diagnosis of an ENETS stage IV neuroendocrine tumour (NET) of the small intestine who developed neurological symptoms. The first patient only had bulbar symptoms and tested positive for acetylcholine receptor antibodies. The second patient had more classical symptoms of fatigable diplopia and muscle weakness of the legs, but no detectable antibodies. The diagnosis of paraneoplastical myasthenia gravis (MG) was postulated. Both patients were treated with pyridostigmine for MG and octreotide for the NETs. Interestingly, treatment of the NETs resulted in improvement of myasthenic symptoms. Paraneoplastic MG has been described to occur with certain malignancies, mainly thymoma. Herein, we prove that the association with gastrointestinal NETs, however, rare, is also one to be considered by clinicians dealing with either of these diseases. The pathogenesis has yet to be elucidated.
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Affiliation(s)
- M A W Hermans
- Department of Internal Medicine Maxima Medical Centre Ds Theodor Fliednerstr 1; 5631BM; Eindhoven The Netherlands
| | - B M L Stelten
- Department of Neurology Canisius Wilhelmina Hospital Weg door Jonkerbos 100, 6532SZ, Nijmegen The Netherlands
| | - H R Haak
- Department of Internal Medicine Maxima Medical Centre Ds Theodor Fliednerstr 1; 5631BM; Eindhoven The Netherlands
| | - W W de Herder
- Department of Internal Medicine Erasmus University Medical Centre Gravendijkwal 230, 3015CE, Rotterdam The Netherlands
| | - M W Dercksen
- Department of Internal Medicine Maxima Medical Centre Ds Theodor Fliednerstr 1; 5631BM; Eindhoven The Netherlands
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20
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Abstract
Paraneoplastic neurological syndromes (PNSs) rarely associate with Hodgkin lymphoma (HL) and non-HLs (NHLs). Except for paraneoplastic cerebellar degeneration (PCD) in HL and dermato/ polymyositis in both HL and NHL, other PNSs are uncommon and have only been reported as isolated case reports or short series. There are several important differences in PNSs when occurring in association with HL and NHL compared with those associated with solid tumors. First, some PNSs such as sensory neuronopathy or Lambert-Eaton myasthenic syndrome rarely occur in lymphomas, whereas others, such as granulomatous angiitis, are only described in HL. Second, onconeural antibodies are absent in most PNSs associated with lymphomas with the exceptions of Tr (δ/notch-like epidermal growth factor-related receptor) in PCD and mGluR5 in limbic encephalitis (LE). The antigens recognized by these antibodies are not expressed in lymphoma cells, suggesting the tumor itself does not trigger the PNS. Third, unlike patients with solid tumors in patients with lymphoma, the PNSs often develops at advanced stages of the disease. Furthermore, the type and frequency of PNSs are different between HL and NHL; whereas LE and PCD occur almost exclusively in patients with HL, sensorimotor neuropathies and dermatomyositis are more frequent in NHL.
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Yeh JH, Lin CC, Chen YK, Sung FC, Chiu HC, Kao CH. Excessive risk of cancer and in particular lymphoid malignancy in myasthenia gravis patients: a population-based cohort study. Neuromuscul Disord 2013; 24:245-9. [PMID: 24332676 DOI: 10.1016/j.nmd.2013.11.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 11/08/2013] [Accepted: 11/14/2013] [Indexed: 01/20/2023]
Abstract
The exact relationship between myasthenia gravis (MG) and extrathymic malignancies has not been established thus far. Occasional cases of MG have been reported in association with lymphoma or other lymphoproliferative disorders. To determine the risk of extrathymic malignancy with particular attention on lymphoid malignancy for MG patients in a large cohort representing 99% of the Taiwan population, claims data from the Taiwan National Health Insurance Database were used to conduct retrospective cohort analyses. The study cohort comprised 3671 MG patients who were 10-fold frequency matched by age and sex, and assigned the same index year without MG. Cox proportional hazard regression analysis was conducted to estimate the risk of cancer. The MG cohort had a 1.74-fold increased risk of developing cancer compared to the comparison cohort (HR=1.74, 95% CI=1.47-2.05). After adjusting for confounders and relative to the cohort, patients with MG had a 2.27-fold increased risk of developing lymphoid malignancies (HR=2.27, 95% CI=1.06-4.88) and a 118.47-fold increased risk of thymus cancer (HR=118.47, 95%=42.57-329.71). This population based retrospective case-control study confirms and extends previous observations on the association between MG and lymphoid malignancies.
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Affiliation(s)
- Jiann-Horng Yeh
- Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Che-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Yen-Kung Chen
- Department of Nuclear Medicine and PET Center, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Hou-Chang Chiu
- Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.
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First reports of serious adverse drug reactions in recent weeks. DRUGS & THERAPY PERSPECTIVES 2012. [DOI: 10.1007/bf03262115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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