Successful treatment of MuSK antibody-positive myasthenia gravis with rituximab

We report on a 56‐year‐old woman with muscle‐specific receptor tyrosine kinase (MuSK) antibody–positive myasthenia with predominant bulbar symptoms and respiratory insufficiency. Conventional immunosuppression (prednisolone, azathioprine, mycophenolate mofetil) could not maintain the clinical improv...

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Bibliographic Details
Published in:Muscle & nerve 2006-04, Vol.33 (4), p.575-580
Main Authors: Hain, Berit, Jordan, Karin, Deschauer, Marcus, Zierz, Stephan
Format: Article
Language:English
Subjects:
Adrenal Cortex Hormones - adverse effects
Adrenal Cortex Hormones - therapeutic use
Anti-Inflammatory Agents - adverse effects
Anti-Inflammatory Agents - therapeutic use
Antibodies - analysis
Antibodies, Monoclonal - therapeutic use
Antibodies, Monoclonal, Murine-Derived
B lymphocytes
B-Lymphocytes - immunology
B-Lymphocytes - metabolism
Biological and medical sciences
Diseases of striated muscles. Neuromuscular diseases
Female
Humans
Immunoglobulin G - metabolism
Immunoglobulin M - metabolism
immunosuppression
Immunosuppressive Agents - therapeutic use
Medical sciences
Middle Aged
Muscle
MuSK antibodies
myasthenia gravis
Myasthenia Gravis - drug therapy
Myasthenia Gravis - genetics
Myasthenia Gravis - immunology
Mycophenolic Acid - adverse effects
Mycophenolic Acid - analogs & derivatives
Mycophenolic Acid - therapeutic use
Neurology
Pharmacology. Drug treatments
Plasma Exchange
Prednisolone - adverse effects
Prednisolone - therapeutic use
Receptor Protein-Tyrosine Kinases - genetics
Receptor Protein-Tyrosine Kinases - immunology
Receptors, Cholinergic - genetics
Receptors, Cholinergic - immunology
Rituximab
T-Lymphocytes - immunology
T-Lymphocytes - metabolism
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Summary:We report on a 56‐year‐old woman with muscle‐specific receptor tyrosine kinase (MuSK) antibody–positive myasthenia with predominant bulbar symptoms and respiratory insufficiency. Conventional immunosuppression (prednisolone, azathioprine, mycophenolate mofetil) could not maintain the clinical improvement initially achieved by repeated plasma exchanges. Therefore, treatment with rituximab was initiated. After 2 months of rituximab treatment, remarkable clinical improvement correlating with a reduction of MuSK serum antibodies was seen. The patient continued to remain remain stable 12 months after initiation of therapy. This case report demonstrates that rituximab may be an effective and tolerable treatment in MuSK antibody–positive myasthenia gravis. Muscle Nerve, 2005
ISSN:0148-639X
1097-4598
DOI:10.1002/mus.20479