| Abstract [eng] |
Multiple sclerosis and other autoimmune diseases of the nervous system are suspected to have a common autoimmune mechanism, as the number of reported co-occurrences of these autoimmune disorders is increasing. Literature suggests different theories on how autoimmune diseases of the nervous system are related and coexist. However, one of the most common neuroimmune diseases that tend to co-occur with multiple sclerosis is myasthenia gravis. The involvement of both T cells and B cells in the pathogenesis of these two diseases is suspected. As the symptoms and clinical course of multiple sclerosis and myasthenia gravis may be similar in some cases, it is difficult to consider the possibility of the coexistence of these disorders. However, laboratory and imagining findings are helpful in distinguishing both diseases and differentiating them from other neurological conditions. Additionally, there can be obstacles in effective treatment selection for patients with coexisting multiple sclerosis and myasthenia gravis. This article presents a clinical case of a woman with previously diagnosed myasthenia gravis who, 12 years later, was admitted to the hospital with new-onset symptoms and was additionally diagnosed with relapsing-remitting multiple sclerosis. Remission was achieved for myasthenia gravis with medications and thymectomy. However, treatment of multiple sclerosis had its challenges, as first-line immunomodulating drugs interferon beta – 1a, dimethyl fumarate was not effective, and a second line treatment with monoclonal antibody medications rituximab and ocrelizumab showed efficacy on both diseases, myasthenia gravis and multiple sclerosis. The presented case highlights the importance considering the manifestation of another disease during the treatment of an already diagnosed disorder. Also, it emphasizes the relevance of further investigation of the link between multiple sclerosis and other autoimmune diseases of the nervous system. |
