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Case report
Myasthenia gravis associated with a pelvic follicular lymphoma
  1. Charlotte Willis1,2,
  2. Max Williamson2,
  3. Nicholas Constantinou1 and
  4. Emily Johns1
  1. 1Gastroenterology Department, Stoke Mandeville Hospital, Aylesbury, UK
  2. 2Radcliffe Department of Medicine, University of Oxford Medical Sciences Division, Oxford, Oxfordshire, UK
  1. Correspondence to Dr Charlotte Willis; charlottewillis{at}doctors.org.uk

Abstract

An 81-year-old woman presented with neck weakness, dysarthria, dysphasia and left-sided ptosis. Myasthenia gravis (MG) was strongly suspected. Voltage gated calcium channel (VGCC) antibodies, associated with Lambert-Eaton myasthenic syndrome (LEMS), were negative. Acetylcholine receptor (AChR) antibody level was 536 nmol/L and diagnosis of MG was confirmed. Imaging revealed a pelvic mass and subsequent biopsy confirmed a pelvic follicular lymphoma. Our searches revealed this to be the first documented case of MG associated with a pelvic follicular lymphoma. She underwent radiotherapy to treat the lymphoma and received both pyridostigmine and immunosuppression to treat the MG. Her AChR antibody level decreased to 38 nmol/L and her MG symptoms resolved aside from head drop which is continuing to improve. Her lymphoma is now in remission. We have presented a case with a successful outcome, which highlights the importance of screening for lymphoma and thymoma in new presentations of MG.

  • haematology (incl blood transfusion)
  • neurology

https://doi.org/10.1136/bcr-2021-248011

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    Footnotes

    • Contributors CW, NC and EJ were involved in the care of the patient. CW collected the case information and wrote the case report with MW. NC and EJ supervised and edited the case report.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.