Rituximab is successful in an HIV-positive patient with MuSK myasthenia gravis

Autor: Thierry Kuntzer, Matthias Cavassini, Jan Novy, R. Du Pasquier, Antonio Carota
Rok vydání: 2011
Předmět:
medicine.medical_specialty
Efavirenz
Gastroenterology
Antibodies
Antibodies
Monoclonal
Murine-Derived
Young Adult
chemistry.chemical_compound
Zidovudine
Ptosis
Internal medicine
HIV Seropositivity
Myasthenia Gravis
Humans
Immunologic Factors
Medicine
Receptors
Cholinergic
business.industry
Receptor Protein-Tyrosine Kinases
virus diseases
Lamivudine
Antibodies/blood
Antibodies
Monoclonal
Murine-Derived/therapeutic use
Female
HIV Seropositivity/complications
HIV Seropositivity/drug therapy
Immunologic Factors/therapeutic use
Myasthenia Gravis/complications
Myasthenia Gravis/drug therapy
Receptor Protein-Tyrosine Kinases/immunology
Receptors
Cholinergic/immunology
medicine.disease
Myasthenia gravis
chemistry
Concomitant
Immunology
Rituximab
Neurology (clinical)
medicine.symptom
business
Viral load
medicine.drug
Zdroj: Neurology, vol. 76, no. 8, pp. 757-758
ISSN: 1526-632X
0028-3878
DOI: 10.1212/wnl.0b013e31820d6290
Popis: There exists almost no literature on how to treat myasthenia gravis (MG) in HIV-infected patients. We report a 21-year-old HIV+ African woman (A3 Centers for Disease Control and Prevention staging) who developed a bulbar form of MG concomitant with significant CD4+ T-cell increase on highly active antiretroviral therapy (HAART) and who was eventually successfully treated by rituximab. This case report provides Class IV evidence that treatment with IV rituximab (2 cycles of 1 g each) was associated with improvement in clinical signs of MG in an HIV-positive patient with MuSK MG. ### Case report. In April 2003, the patient started HIV treatment with zidovudine, lamivudine, and efavirenz. Although HIV viral load became undetectable, immune restoration was slow. In 2005, zidovudine was switched to tenofovir. Within 8 months, she showed a marked increase (235%) in CD4+ lymphocyte cell count (from 244 to 575/mm3) (figure). Concomitant with this count peak, the patient presented with intermittent diplopia, eyelid ptosis, dysarthria, dysphagia, and fatigue in the upper limbs (MG composite score; figure). Clinical examination revealed lymphadenopathy, symmetric ptosis, weakness, and fatigability involving the facial, pharyngeal, palatal, tongue, neck, shoulder abductor, and respiratory muscles. …
Databáze: OpenAIRE
Externí odkaz: