A case of myasthenia gravis following alopecia areata

We present a case of myasthenia gravis that occurred after alopecia areata and evaluate the literature on the comorbidity of alopecia and myasthenia gravis. A 41-year-old male noticed hair loss on his scalp 4 months ago, and his hair loss progressed with drooping of both upper eyelids and diplopia. Physical and laboratory examination identified the comorbidity of myasthenia gravis and alopecia areata. Prednisolone 10 mg/day and tacrolimus 3 mg/day were administered for 7 days following hospitalization, which served to improve diplopia and ptosis. Following methylprednisolone therapy, hair loss in alopecia areata improved without the enlargement of bald areas. Based on the literature review, a total of 29 cases with alopecia and myasthenia gravis including our case have been reported. Among them, seven cases of myasthenia gravis developed after alopecia. The average time for the onset of myasthenia gravis after alopecia was 16.6 months. Four cases showed other autoimmune disease comorbidity, such as vitiligo, lichen planus, cutaneous lupus erythematosus, and pemphigus foliaceus, suggesting the involvement of Th1-significant immunological states in these patients.