Thyroid gland tumour, pemphigus foliaceus and myasthenia gravis in the daughter of a woman with myasthenia gravis

Abstract

We describe a rare case of pemphigus foliaceus associated with familial myasthenia gravis (MG). A 35-year-old woman developed MG during oral corticosteroid treatment for pemphigus foliaceus. She had been operated on for a thyroid gland tumour that was confirmed histopathologically to be papillary carcinoma without metastasis. At the time of treatment, her mother had had MG for 30 years and undergone thymectomy 22 years ago. A specific ELISA technique showed that antidesmoglein 1 antibody was present in the daughter. There are many reports of multiple diseases such as pemphigus, thymoma, malignancy, and other autoimmune diseases associated with MG. However, familial MG following pemphigus foliaceus has not been reported previously.

Prevalence of myasthenia gravis and associated autoantibodies in paraneoplastic pemphigus and their correlations with symptoms and prognosis

“…Analogously, MG is an autoimmune NMJ disorder. It is occasionally associated with other autoimmune diseases including pemphigus . Five human cases and one feline case of PNP with MG have been reported so far, four of which had thymoma and two had CD .…”

“…It is occasionally associated with other autoimmune diseases including pemphigus. 8,[27][28][29] Five human cases and one feline case of PNP with MG have been reported so far, four of which had thymoma and two had CD. [8][9][10][11][12][13] MG and pemphigus associations seemed sporadic in our study, and among the patients with PV and PF who we examined, none complained of any typical muscle weakness.…”

Autoimmune diseases in patients with pemphigus and their first‐degree relatives

“…Several associations of pemphigus with other autoimmune diseases have been reported, including myasthenia gravis, [1][2][3][4] Sjögren's syndrome, 5 rheumatoid arthritis, 5 and autoimmune thyroid disease. [6][7][8][9][10][11][12][13] First-degree family members of patients with pemphigus have been shown to have a significant increase in the prevalence of autoimmune diseases compared with controls.…”

Pemphigus Vulgaris with Solitary Toxic Thyroid Nodule

“…The association of autoimmune diseases in the same patient has been reported, with a tendency that approaches 25% [ 8 ]. Pemphigus vulgaris was reported to be associated with autoimmune diseases including rheumatoid arthritis, Sjogren's syndrome [ 3 ], myasthenia gravis [ 2 ], and autoimmune thyroid diseases, namely, Graves' disease and Hashimoto's thyroiditis [ 4 – 7 ].…”

“…Pemphigus is a term applied to a group of autoimmune chronic, sometimes fatal, blistering disorders characterized clinically by flaccid blisters that arise on skin and mucous membranes [ 1 ]. It is reported to be associated with other autoimmune diseases as myasthenia gravis [ 2 ], Sjogren's disease, rheumatoid arthritis [ 3 ], and autoimmune diseases of the thyroid [ 4 – 7 ] and accordingly when a pemphigus patient is thyrotoxic, the expected cause would be Graves' disease, which is one of the autoimmune thyroid diseases. Herein we report a case of pemphigus vulgaris associated with thyrotoxicosis due to autonomous toxic nodule.…”