A 38 year old wheelchair bound female self referred to neurology for a multisystem complex. About age 23, she began suffering from numerous clinical syndromes and symptoms including postural orthostatic tachycardia syndrome, adrenal insufficiency and Graves', gastrointestinal and skin conditions with severe intermittent erythema patches, severe fatigue, fibromyalgia, chronic pain on opioids, migraine and other symptoms which lead to a homebound state for many years. On exam her vital signs were compensated by glucocorticoids, she had sensory ataxia with severe gait impairment. Laboratories targeting the neurologic findings revealed high titers of autoantibodies against both the nicotinic ganglionic acetylcholine receptor (nAChR) and ganglioside GD1b.

Following three months of IVIG therapy, she ambulated and shopped outside her home for the first time in 15 years.  Her skin condition resolved.  After several more months, she was able to reduce her opioids and cortisone doses, and her gastrointestinal issues resolved.  Repeat laboratories showed very decreased GD1b titers, but less so the nAChR titers.  She continues with IVIG treatments.