Abstract Details

Title Autoimmune Myocarditis Associated to Seropositive Myasthenia Gravis

Topic Neuromuscular and Clinical Neurophysiology (EMG)

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 1-009

Objective To bring awareness about life-threatening complications including cardiac involvement associated with myasthenic crisis in seropositive Myasthenia Gravis (MG) patients with thymoma.

Background Myasthenia gravis is an autoimmune disorder that targets skeletal muscle including striated cardiac muscle. Cardiac manifestations of myasthenia gravis have been described and a higher prevalence has been reported in the presence of thymoma (10-15%).

Design/Methods Case of a 31-year-old male patient with seropositive myasthenia gravis and thymoma who was hospitalized due to elevated liver enzymes 3 months after diagnosis. During hospitalization, the patient complained of chest pain and was found with elevated cardiac enzymes. Patient underwent cardiac catheterization with normal results. He developed respiratory failure and was placed on mechanical ventilation. Cardiac enzymes remained elevated and electrocardiogram continued to show findings suggestive of myocardial infarction. Creatine phosphokinase was ordered and found elevated (>1600). 2D-echo with reduced EF 30-35%, small pericardial effusion. Pulmonary CT angiogram without evidence of pulmonary embolism. Cardiac MRI with severely depressed left ventricle (LV) systolic function <35%, hypokinesia of the inferior mid to apical LV wall, small pericardial effusion, findings consistent with thymoma. Endomyocardial biopsy with diffuse lymphocytic interstitial inflammatory infiltrate ad myocyte damage consistent with myocarditis. Solumedrol 500mg daily for three days was provided with significant improvement.

Results N/A

Conclusions Heart muscle involvement of myasthenia gravis and its underlying pathophysiology needs to be carefully evaluated in these patients to establish the appropriate management plan. These include autoimmune myocarditis, giant cell myocarditis, stress-induced cardiomyopathy (i.e. takotsubo), pericarditis post-irradiation for thymoma, arrhythmias, medication-induced cardiac disease, among others. In our case, a younger patient presented with these complications almost at the same time of his myasthenic crisis. The importance of recognizing these potential complications in myasthenia gravis is imperative to avoid life-threatening pathology. Although prognosis can be poor, if recognized early, treatment with immunosuppression can be beneficial and improve outcome.

Authors/Disclosures
Sonia M. Caraballo-Cartagena, MD (Advocate Health Care) PRESENTER	Dr. Caraballo-Cartagena has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB. Dr. Caraballo-Cartagena has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Argenx. Dr. Caraballo-Cartagena has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Caraballo-Cartagena has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for UCB. Dr. Caraballo-Cartagena has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Alexion. Dr. Caraballo-Cartagena has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Takeda. Dr. Caraballo-Cartagena has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Alnylam. Dr. Caraballo-Cartagena has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Argenx.
David Q. Atkins, MD (University of Puerto Rico Neurology Department)	No disclosure on file
	No disclosure on file
Gishlaine Alfonso, MD, FAAN	Dr. Alfonso has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion .

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