Dysphagia and Dysphonia, a Pairing of Symptoms Caused by an Unusual Pair of Diseases: Castleman’s Disease and Myasthenia Gravis

Abstract

Objectives: To describe a case of coincident Castleman’s disease and myasthenia gravis that initially presented as rapidly progressive dysphagia and dysphonia and to review the unique pathophysiology of these two uncommon diagnoses. Methods: Case report and literature review. Results: Castleman’s disease, angiofollicular or giant lymph node hyperplasia, is a rare benign lymphoid proliferation. Traditionally, the disease is classified based on histologic and clinical characteristics. Fewer than 10 cases with concurrent myasthenia gravis have been reported. Myasthenia gravis and thymic epithelial tumors are both associated with acetylcholine receptor antibody. While patients with isolated Castleman’s disease are usually asymptomatic, those who have concurrent myasthenia gravis and undergo surgical treatment are at increased risk of postoperative myasthenic crisis. Both pre- and postoperative plasmapheresis are suggested to improve muscle strength and prevent severe postoperative complications. Conclusions: In the setting of multiple cranial neuropathies including velopalatal insufficiency and bilateral ptosis it is important to consider myasthenia gravis. Castleman’s disease occurs rarely in conjunction with myasthenia gravis but may increase the risk of myasthenic crisis.

A Case Report of Subclinical Myasthenia Gravis Associated with Castleman’s Disease

“…Between 2010 and 2020, 2 cases of Castleman disease were documented, one of which was associated with myasthenia gravis [ 7 , 8 ]. That patient underwent resection of a mediastinal tumor, which was complicated by a follicular dendritic cell sarcoma.…”

“…Treatment with an anticholinesterase agent and corticosteroids was successful. The second report showed that the presence of Castleman disease in patients with myasthenia gravis increases the risk of developing a myasthenic crisis, which is considered a serious postoperative complication [ 7 , 8 ].…”

A Case of Unicentric Castleman Disease with Concomitant Myasthenia Gravis and Persistent Left Superior Vena Cava

“…In a previous report, up to 37.5% of these cases were associated with myasthenic crisis after surgical resection, an association much higher than the 5.4% incidence of myasthenic crisis following surgical resection of thymic epithelial tumors [8,9]. Table 1 includes the initial cases reported by Ishikawa et al, in addition to those reported after 2013 [3,[13][14][15][16][17][18]. One case of Castleman disease complicated by both myasthenia gravis and paraneoplastic pemphigus also included a myasthenic crisis; however, the crisis occurred during a hospitalization after a mucosal biopsy and not after the surgical resection of the mass [13].…”