Acta Scientific Women's Health (ASWH)(ISSN: 2582-3205)

Mini Review Volume 2 Issue 3

A Case of Myasthenia Gravis and Polymyositis developed in Systemic Lupus Erythematosus Patient and Managed by Rituximab

Rihab Mohammed Hassan Ali1,2, Mohammed Elmujtba Adam Essa3*, Wafa Hassan Ahmed1, Noha Ibrahim Ahmed Eltahir1,4, Ziryab Imad Taha1,3,5, Abdelkareem A Ahmed3,6,7*, Ayman Sati Sati Mohammed3, Sulafa Eisa Mohammed Ibrahim8, Elnour Mohammed Elagib1,4

1Department of Rheumatology, Sudan Medical Specialization Board, Khartoum, Sudan
2Department of Medicine, Faculty of Medicine, University of Science and Technology, Khartoum, Sudan
3Department of Clinical Medicine, Medical and Cancer Research Institute, Nyala, Sudan
4Department of Rheumatology, Omdurman Military Hospital, Khartoum, Sudan
5Department of Medicine and Rheumatology, Faculty of Medicine, University of Bahri, Khartoum, Sudan
6Department of Physiology and Biochemistry, Faculty of Veterinary Science, University of Nyala, Nyala, Sudan
7Biomedical Research Institute, Darfur College, Nyala, Sudan
8Department of Internal Medicine, National Ribat University, Khartoum, Sudan

*Corresponding Author: Mohammed Elmujtba Adam Essa Adam, Department of Clinical Medicine, Medical and Cancer Research Institute (MCRI), Nyala, Sudan.

Received: November 21, 2019; Published: January 09, 2020



  Systemic lupus erythematosus (SLE), myasthenia gravis (MG) and polymyositis (PM) are three autoimmune diseases that have upper incidence in young women, SLE, MG and PM are three different clinical syndromes which can be coexist or precede each other’s, although their occurrence and presence in the same patients are uncommon and rare. The aims of this study are to report the first association of the three immunological diseases in a single patient. Here we report a 36 years old lady with confirmed SLE and on hydroxychloroquine (HCQ) and tapered steroid, 20 months later developed MG, then Creatine Kinase (CK), nerve conduction studies (NCS) and electromyography (EMG) relieved the diagnosis of PM. The patient received four dosages of intravenous immunoglobulin but developed allergic reactions, then rituximab been administrated and all the complained symptoms resolved and the patient returned to her normal daily activities.

Keywords: Systemic Lupus Erythematosus; Myasthenia Gravis; Polymyositis; Rituximab



  1. Nagarajan M., et al. “Systemic Lupus Erythematosus and Myasthenia Gravis: A Rare Association”. Indian Journal of Nephrology 29.1 (2019): 62-64.
  2. Zhang B., et al. “Autoantibodies to lipoprotein-related protein 4 in patients with double-seronegative myasthenia gravis”. Archives of Neurology 69.4 (2012): 445-51.
  3. Mozo L., et al. “A case of polymyositis associated with the presence of anti-proliferating cell nuclear antigen antibodies, a marker typically considered SLE specific”. Lupus 19.8 (2010): 1002-1003.
  4. Pons-Estel GJ., et al. “Understanding the epidemiology and progression of systemic lupus erythematosus”. Seminars in Arthritis and Rheumatism 2010 39.2 (2010): 257-268.
  5. Chakravarty EF., et al. “Prevalence of adult systemic lupus erythematosus in California and Pennsylvania in 2000: estimates obtained using hospitalization data”. Arthritis and rheumatism 56.6 (2007): 2092-2094.
  6. Tiffin N., et al. “Lupus in Africa: Can we dispel the myths and face the challenges?” Lupus (2013): 23.
  7. Kumar K., et al. “Challenges of ethnicity in SLE”. Best Practice and Research Clinical Rheumatology 23.4 (2009): 549-561.
  8. Elagib E., et al. “Catastrophic Antiphospholipid Syndrome in Combination with SLE Treated by Rituximab: A Case Report and Literature Review”. Lupus: Open Access 4 (2019): 137.
  9. Sîrbu E., et al. “Systemic lupus erythematosus followed by myasthenia gravis: a rare association”. Central European Journal of Medicine 8.6 (2013): 799-802.
  10. McDonagh JE and Isenberg DA. “Development of additional autoimmune diseases in a population of patients with systemic lupus erythematosus”. Annals of the Rheumatic Diseases 59.3 (2000): 230-232.
  11. Castrejón I., et al. “Association between myasthaenia gravis and systemic lupus erythematosus: three case reports and review of the literature”. Scandinavian Journal of Rheumatology 40 (2011): 486-490.
  12. Song J., et al. “Meta-Analysis of Polymyositis and Dermatomyositis Microarray Data Reveals Novel Genetic Biomarkers”. Genes 10.11 (2019).
  13. Pasnoor M., et al. “Diagnosis of Myasthenia Gravis”. Neurologic clinics 36 (2018): 261-274.
  14. Mustafa MS., et al. “Delayed Diagnosis of Atypical Presentation of Myasthenia Gravis”. European journal of Case Reports in Internal Medicine 5.2 (2018): 000785.
  15. Hostmann A., et al. “Peripheral B cell abnormalities and disease activity in systemic lupus erythematosus”. Lupus 17.12 (2008): 1064-1069.
  16. Kigawa N., et al. “Development of myasthenia gravis in systemic lupus erythematosus”. European Journal of Case Reports in Internal Medicine 1 (2014).
  17. Banica L., et al. “Quantification and molecular characterization of regulatory T cells in connective tissue diseases”. Autoimmunity 42.1 (2009): 41-49.
  18. Casado E., et al. “Antimalarial myopathy: an underdiagnosed complication? Prospective longitudinal study of 119 patients”. Annals of the Rheumatic Diseases 65 (2006): 385-390.
  19. Mai W., et al. “Up-regulated expression of Fas antigen in peripheral T cell subsets in patients with myasthenia gravis”. Clinical and Investigative Medicine 35.5 (2012): E294.
  20. Mahmoud ZIT., et al. “The role of hydroxychloroquine as monotherapy in managing early undifferentiated arthritis: a prospective hospital-based study”. Global Journal of Public Health Medicine 1 (2019): 52-62.
  21. Ungprasert P., et al. “Clinical features of inflammatory myopathies and their association with malignancy: a systematic review in Asian population”. ISRN Rheumatology (2013).
  22. Tomasová Studýnková J., et al. “The role of MRI in the assessment of polymyositis and dermatomyositis” (2007).
  23. Volochayev R., et al. “Laboratory Test Abnormalities are Common in Polymyositis and Dermatomyositis and Differ Among Clinical and Demographic Groups”. The Open Rheumatology Journal 6 (2012): 54-63.
  24. Yang F., et al. “Electrophysiological and clinical examination of polymyositis: a retrospective analysis”. The American Journal of the Medical Sciences 348.2 (2014): 162-166.
  25. Garton MJ and Isenberg DA. Clinical features of lupus myositis versus idiopathic myositis: a review of 30 cases”. British Journal of Rheumatology 36 (1997): 1067-1074.
  26. Kilani B., et al. “Association of systemic lupus erythematosus and dermatopolymyositis”. La Tunisie medicale 83 (2005): 230-232.
  27. Rostic G., et al. “Systemic lupus erythematosus and dermatomyositis--case report”. Srpski arhiv za celokupno lekarstvo 133 (2005): 137-140. 
  28. Maazoun F., et al. “Systemic lupus erythematosusmyositis overlap syndrome: report of 6 cases”. Clinics and Practice 1.4 (2011): e89.
  29. Liang Y., et al. “Associated Variables of Myositis in Systemic Lupus Erythematosus: A Cross-Sectional Study”. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research 23 (2017): 2543-2549.
  30. Levine TD. “Rituximab in the treatment of dermatomyositis: an open-label pilot study”. Arthritis and Rheumatism 52.2 (2005): 601-607.


Citation: Abdelkareem A Ahmed., et al. “A Case of Myasthenia Gravis and Polymyositis developed in Systemic Lupus Erythematosus Patient and Managed by Rituximab”. Acta Scientific Women's Health 2.3 (2020): 15-18.


Acceptance rate35%
Acceptance to publication20-30 days

Indexed In

News and Events

  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.
  • Submission Timeline for Upcoming Issue
    The last date for submission of articles for regular Issues is May 20, 2024.
  • Publication Certificate
    Authors will be issued a "Publication Certificate" as a mark of appreciation for publishing their work.
  • Best Article of the Issue
    The Editors will elect one Best Article after each issue release. The authors of this article will be provided with a certificate of "Best Article of the Issue"
  • Welcoming Article Submission
    Acta Scientific delightfully welcomes active researchers for submission of articles towards the upcoming issue of respective journals.

Contact US