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      Minimal change disease in a patient with myasthenia gravis : A case report

      case-report
      , MD a , , MD b , c , d , e
      Medicine
      Wolters Kluwer Health
      minimal change disease, myasthenia gravis, nephrotic syndrome

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          Abstract

          Background:

          Myasthenia gravis superimposed with proteinuria is a very rare disorder with only 39 cases reported so far. Of these cases, the most commonly associated disorder is minimal change disease. Myasthenia gravis and minimal change disease are both related to the dysfunction of T lymphocytes and hence the 2 disorders may be connected.

          Methods:

          Here we report the first case on a patient diagnosed with myasthenia gravis concurrently with the minimal change disease, and it was presented in the absence of thymoma or thymic hyperplasia.

          Results:

          Treatment for myasthenia gravis also lowered proteinuria of minimal change disease. He ever experienced good control for myasthenia gravis and minimal change disease. However, pneumonia related septic shock occurred to him and finally he was dead. Minimal change disease is generally considered to occur subsequent to the onset of myasthenia gravis with causal association. After extensive literature review, we noted only 47.8% minimal change disease had occurred after the onset of myasthenia gravis.

          Conclusion:

          Minimal change disease mostly occurs in children and if diagnosed in adults, clinicians should search for a potential cause such as myasthenia gravis and other associated thymic disorders.

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          Most cited references8

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          Myasthenia gravis.

          D Drachman (1994)
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            The spectrum of diseases associated with thymoma. Coincidence or syndrome?

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              Thymoma and the nephrotic syndrome: a report of a case.

              A 48-year-old male presented with the nephrotic syndrome 3 years after resection and irradiation of a thymoma. Renal biopsy revealed membranous glomerulonephritis by electron microscopy. IgA, IgG, and C3 deposition were present in the glomerular basement membrane by immunofluorescence. There was no evidence of other autoimmune diseases or causes of the membranous glomerulonephritis. He has continued to have proteinuria and edema 1 year later.
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                Author and article information

                Journal
                Medicine (Baltimore)
                Medicine (Baltimore)
                MEDI
                Medicine
                Wolters Kluwer Health
                0025-7974
                1536-5964
                September 2016
                30 September 2016
                : 95
                : 39
                : e5008
                Affiliations
                [a ]Department of Family Medicine, Cheng Ching General Hospital
                [b ]Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital
                [c ]School of Medicine, China Medical University
                [d ]Department of Life Science, Tunghai University, Taichung
                [e ]Department of Medicine, Nation Yang Ming University, Taipei, Taiwan.
                Author notes
                []Correspondence: Shang-Feng, Tsai, Division of Nephrology, Department of Medicine, Taichung Veterans General Hospital, Taichung, Taiwan (e-mail: s881056@ 123456gmail.com ).
                Article
                05008
                10.1097/MD.0000000000005008
                5265957
                27684864
                0a4531db-70dc-457e-a357-7dfb97e7d583
                Copyright © 2016 the Author(s). Published by Wolters Kluwer Health, Inc. All rights reserved.

                This is an open access article distributed under the Creative Commons Attribution-NoDerivatives License 4.0, which allows for redistribution, commercial and non-commercial, as long as it is passed along unchanged and in whole, with credit to the author. http://creativecommons.org/licenses/by-nd/4.0

                History
                : 25 July 2016
                : 2 September 2016
                : 7 September 2016
                Categories
                5200
                Research Article
                Clinical Case Report
                Custom metadata
                TRUE

                minimal change disease,myasthenia gravis,nephrotic syndrome

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