Myasthenia gravis (MG) is an autoimmune disease due to pathogenic antibodies (Abs) against components of the neuromuscular junction (NMJ). The typical manifestation is localized or generalized muscle weakness which increases after exercise and fluctuates during the day. MG affected patients could be classified into different subgroups referring to Abs and clinical presentation. Abs are more frequently against the acetylcholine receptor (AChR). However, Abs against muscle-specific kinase (MuSK) and other NMJ proteins as lipoprotein related protein 4 (LRP4) identify rarer forms of MG. AChR-MG includes three subtypes: early-onset (EOMG), late-onset (LOMG), and thymoma-associated. EOMG manifests before the age of 50 years, generally associated with thymic abnormalities. Patients with LOMG are mainly men with generalized disease and normal or atrophic thymus gland, occurring after the age of 50 years.

Thymoma-associated MG has a more severe course than non-thymomatous form. Finally, MuSK-MG usually occurs in adulthood without thymus pathological changes. It affects cranial and bulbar muscles, often associated with tongue atrophy and neck and respiratory muscles involvement . Double seropositivity for AChR and MuSK Abs has been rarely detected. We report herein a man with a very late onset MG, who is moreover characterized by double seropositivity at the time of the diagnosis.

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Journal of Journal of Autoimmune Disorders