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Case Reports 2018
Medical Case Reports
ISSN: 2471-8041
Page 74
May 28-29, 2018
London, UK
8
th
Edition of International Conference on
Clinical and Medical Case Reports
A
14 years old female developed acute ptosis of the right
eye at three years age followed by the second eye and
diagnosed as myasthenia gravis after a positive response to SC
neostigmine and normal fundoscopy, brain CT scan, and general
investigations. The condition failed to respond to adequate
Mestinon (Pyridostigmine) therapy. Five months later developed
rolling of the eyes, convergent squint, bilateral ophthalmoplegia,
proptosis, goiter and signs of Graves’ disease. Investigations
showed high T4, low TSH, normal anti acetylcholine, ANA, anti
SM antibodies, EEG, brain MRI, and CT scan of the chest. The
condition diagnosed as a coexistence of myasthenia gravis with
Graves’ disease. Carbimazole 5 mg/day was added but still the
ophthalmoplegia and ptosis persist. Prednisolone added for three
months but no response. As she passed more than three years
with the diseasewithout developing systemic signs ofmyasthenia
gravis, the condition then diagnosed as ocular myasthenia gravis
with Graves’ disease. With age, the ptosis and ophthalmoplegia
interfered with her social and school performance in spite of the
increased Mestinon therapy to 45 mg 6 hourly. In 2016 when
she was 12 years old, reevaluation investigations showed all
normal except enlarged thymus on CT scan of the chest and
positive nasalis muscle EMG. Thymectomy was done after
plasmapheresis. Three weeks after operation, ptosis starts to
improve followed by gradual improvement of ophthalmoplegia.
Now, after 2 years from operation, ptosis and ophthalmoplegia
improved to about 70% and the euthyroid goiter reduced in size
on only Mestinon 60 mg six hourly without antithyroid therapy.
zaidrasheedalani@yahoo.comCoexistence of ocular myasthenia gravis and Graves’ disease in
a three years old female
Med Case Rep. 2018, Volume 4
DOI: 10.21767/2471-8084-C1-003
Zaid Rasheed Al Ani
1University of Anbar, Iraq
2Al-Ramadi Teaching Hospital for Maternity and Children, Anbar, Iraq