PMID- 28424453
OWN - NLM
STAT- MEDLINE
DCOM- 20171201
LR  - 20190609
IS  - 1941-5923 (Electronic)
IS  - 1941-5923 (Linking)
VI  - 18
DP  - 2017 Apr 20
TI  - Comorbid Human Immunodeficiency Virus (HIV) and Muscle-Specific Kinase (MuSK) 
      Myasthenia Gravis: A Case Report and Literature Review.
PG  - 427-430
AB  - BACKGROUND HIV infections with concomitant immunologically-mediated disorders 
      have been frequently described but there has been little research on the 
      association between HIV and myasthenia gravis. MuSK myasthenia gravis coexisting 
      with HIV is an even a rarer entity and can occur as a part of immune restoration 
      disease. We report the case of a patient with asymptomatic HIV infection who 
      presented with new-onset MuSK myasthenia gravis. CASE REPORT A 44-year-old 
      African-American woman with HIV since 2004 and on highly active antiretroviral 
      therapy (HAART) presented to the ED with complains of double vision and 
      difficulty swallowing for 2 weeks. The patient was intermittently on HAART 
      therapy. On examination, she had bilateral ptosis, weak orbicularis oris and 
      orbicularis oculi, along with mild lateral gaze palsy of the left eye. Her CD4 
      count was 383 and the viral load was undetectable. An MRI of the brain produced 
      normal results and a CT chest did not show thymus enlargement. Due to worsening 
      symptoms and high suspicion for myasthenia gravis, she was started on IVIG at 0.4 
      mg/kg/day for 5 days, and her symptoms markedly improved. She was found to have 
      strongly positive MuSK antibody and negative Ach receptor antibody. Repetitive 
      nerve stimulation showed a 13% decrease in the right median nerve, which 
      confirmed the diagnosis. She was subsequently discharged to home on 
      pyridostigmine. Azathioprine was added at clinic follow-up. The patient continues 
      to improve. CONCLUSIONS As the use of antiretroviral therapy increases, immune 
      reconstitution syndromes have become more common. Rare associations like HIV and 
      MuSK myasthenia gravis are being increasingly reported. The use of 
      immunosuppressants in the treatment of these conditions should be carefully 
      evaluated.
FAU - Sherpa, Michael
AU  - Sherpa M
AD  - Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens 
      Hospital Center, Jamaica, NY, USA.
FAU - Metai, Ravi K
AU  - Metai RK
AD  - Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens 
      Hospital Center, Jamaica, NY, USA.
FAU - Kumar, Viki
AU  - Kumar V
AD  - Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens 
      Hospital Center, Jamaica, NY, USA.
FAU - Hirachan, Tinu
AU  - Hirachan T
AD  - Department of Research, Maimonides Medical Center, Brooklyn, NY, USA.
FAU - Ahmed, Kawser U
AU  - Ahmed KU
AD  - Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens 
      Hospital Center, Jamaica, NY, USA.
FAU - Atkinson, Sharon J
AU  - Atkinson SJ
AD  - Department of Neurology, Icahn School of Medicine at Mount Sinai, Queens Hospital 
      Center, Jamaica, NY, USA.
LA  - eng
PT  - Case Reports
PT  - Journal Article
PT  - Review
DEP - 20170420
PL  - United States
TA  - Am J Case Rep
JT  - The American journal of case reports
JID - 101489566
RN  - 0 (Antibodies)
RN  - 0 (Receptors, Cholinergic)
RN  - EC 2.7.10.1 (MUSK protein, human)
RN  - EC 2.7.10.1 (Receptor Protein-Tyrosine Kinases)
SB  - IM
MH  - Adult
MH  - Antibodies/*blood
MH  - Female
MH  - HIV Infections/*complications
MH  - Humans
MH  - Myasthenia Gravis/*complications
MH  - Receptor Protein-Tyrosine Kinases/*immunology
MH  - Receptors, Cholinergic/*immunology
PMC - PMC5405782
COIS- Conflict of interest: None declared Conflicts of interest None.
EDAT- 2017/04/21 06:00
MHDA- 2017/12/02 06:00
PMCR- 2017/04/20
CRDT- 2017/04/21 06:00
PHST- 2017/04/21 06:00 [entrez]
PHST- 2017/04/21 06:00 [pubmed]
PHST- 2017/12/02 06:00 [medline]
PHST- 2017/04/20 00:00 [pmc-release]
AID - 903108 [pii]
AID - 10.12659/ajcr.903108 [doi]
PST - epublish
SO  - Am J Case Rep. 2017 Apr 20;18:427-430. doi: 10.12659/ajcr.903108.