Myasthenia with interesting systemic associations – A case series

Myasthenia gravis (MG) is an autoimmune disorder with a highly variable clinical expression. Ocular symptoms are the presenting features in 40% patients but MG is restricted to ocular muscles in 15%. Myasthenia gravis is often associated with other autoimmune diseases. Case details of ten myasthenic patients visiting ophthalmology department over two years in a tertiary care hospital were analyzed. Five of them had interesting systemic associations. One patient presented with coexisting thyroid ophthalmopathy and ocular myasthenia. Because of the clinical overlap of ocular manifestations in myasthenia and Graves' disease, one of the two conditions may be missed. Two patients had thymic mass. Presence of thymoma and prognostic implications are highlighted. One patient had thymic cyst, pemphigus and diabetes mellitus. This assortment of autoimmune conditions has not been reported in literature. One patient had associated Parkinson's disease. Myasthenia gravis presents with a highly variable clinical spectrum and is associated with a cluster of autoimmune diseases. This unfortunate association is not widely appreciated. This report highlights the importance of detecting systemic associations of MG. The clinical relevance of these associations in diagnosis and management of myasthenia are discussed.