Myasthenia gravis with Holmes-Adie syndrome:a case report

VernacularTitle:伴有Holmes-Adie综合征的重症肌无力一例
Author: Yuhui CHEN ¹ ; Shifang HOU ; Tao GONG ; Xianhao XU ; Hua ZHANG
Author Information

1. 国家老年医学中心神经内科
Keywords: Myasthenia gravis; Holmes-Adie syndrome; Thymoma
From: Chinese Journal of Neurology 2018;51(12):985-986
CountryChina
Language:Chinese
Abstract: Holmes-Adie syndrome (HAS) is a clinical syndrome mainly characterized by tonic pupil and disappearance of tendon reflex. It is mostly idiopathic and can also be seen in cerebral diseases, such as trauma, infection and tumors. However, it is rarely reported to be accompanied with myasthenia gravis (MG). We report a case of MG and HAS, whose clinical manifestations were fluctuation of limb weakness, breathing difficulties, right ptosis. Her pupils were unequal: the left pupil was 3 mm, the right pupil was 2 mm, direct and indirect light reflex was slow in left pupil, and right pupil was sensitive to light reflex. The left eye pupil shrank to 2 mm after dripped pilocarpine diluent for 10 minutes, while the right pupil was still 2 mm. Chest CT examination revealed thymoma. After treatment with thymectomy, glucocorticoid, immunoglobulins and tacrolimus, her symptoms of MG were improved, but the left pupil diameter and light reflex were not changed. Combined with the patient's symptoms, physical signs and examinations, this patient was diagnosed as MG accompanied with HAS.