Abstract
Comorbidity of Polymyositis and Myasthenia Gravis in HIV Patients Treated with Rituximab
Author(s): Lourdes de Fatima Ibanez Valdes, Sibi Sebastian Joseph and Humberto Foyaca Sibat*Background: Comorbidity of Myasthenia Gravis (MG) and Polymyositis (PM) is uncommon. In places like South Africa, where the prevalence of HIV is very high, any combination of associated diseases is possible. Few cases of MG/PM have been reported in the medical literature, and different therapeutic modalities have been applied. The primary aid of this study is to review the medical literature looking for the frequency of this comorbidity, its clinical features, and therapeutic modalities.
Methods: We searched the medical literature, looking for published articles on "comorbidity of MG"; "Association of MG/PM/DM/HIV/AIDS", "MG and Immune disorders"; OR "Treatment of MG/PM/DM/HIV/AIDS"; OR "Management of MG/AD"; OR "Rituximab in MG/PM/DM/HIV/AIDS" OR "MG/PM/DM/HIV myopathy"; OR "MG/Myositis" OR "Neuromuscular Junction Disorders (NMJD)/PM/DM/HIV/AIDS, OR "Inflammatory Myopathy (IM)/MG/HIV/AIDS".
Results: All selected manuscripts were peer-reviewed, and no one included MG/NMJD/PM/DM/HIV/AIDS treated with RTX. Case report: A 24-years-old HIV female on HAART complaining of the progressive bilateral and symmetrical proximal weakness of the four limbs with an inability to climb stairs and even lift the head off the bed, get up from a sitting position, lift heavy objects, and overhead abduction of the arm. Laboratory investigations show significantly elevated CK level in the blood, AChR ab positive, EMG findings confirmed diagnosis of MG and muscle biopsy confirmed PM. The patient was treated with RTX and improved dramatically.
Comments and concluding remarks: We have hypothesized the pathophysiology of this comorbidity and their good respond to RTX. However, further well-designed investigations should be done to clarify the overall immune mechanisms that cause these complicated pathologic features. This is the first article on this issue reported in the medical literature, as far as we know.