The coincidence of Guillain-Barré syndrome and myasthenia gravis

Background

The occurrence of both Guillain-Barré syndrome (GBS) and myasthenia gravis (MG) in the same individual is rare. The underlying pathophysiology of this case was assumed to be an autoimmune humoral mechanism. Molecular mimicry, in which a cross-reaction occurs between autoantibodies and the myelin sheath of peripheral nerves and acetylcholine receptors of the neuromuscular junction, cannot be excluded as an underlying cause.

Case presentation

An 18-year-old female presented with symptoms of generalized weakness and distal weakness in both upper and lower extremities, more pronounced on the right side, and with associated right foot drop and bilateral ptosis. An electrophysiological study was performed and the acetylcholine receptor antibody titer determined. The patient was diagnosed with GBS and MG.

Conclusions

GBS and MG are two different neurological entities with different pathophysiologies. New-onset or persistence of symptoms in a patient with GBS treated with intravenous immunoglobulins or plasmapheresis should prompt a probe for another autoimmune neurological illness, particularly autoimmune neuromuscular disorders such as MG.