A 32-Year-Old Palestinian Female Patient Diagnosed with Systemic Lupus Erythematosus Two Years After Being Diagnosed with Myasthenia Gravis: A Case Report with Literature Review

Systemic lupus erythematosus (SLE) is a chronic, systemic inflammatory autoimmune disorder defined by the presence of several autoantibodies that affect multiple organs.Myasthenia gravis (MG) is an organ-specific autoimmune condition characterized by the presence of several autoantibodies.However, the coexistence of SLE and MG is rare, with only a few cases reported in the literature. Case PresentationWe report a case of a female patient who presented to the neurology clinic with generalized weakness, fatigue, dyspnea, dysphagia, and dysphonia.She was diagnosed with anti-acetylcholine receptor antibody-positive MG.CT was normal and the EMG was normal.After two years she developed polyarthralgia, oral ulcers, and photosensitivity.Bloodwork revealed a positive antinuclear antibodies (ANA) test.She was diagnosed with SLE and was initiated on hydroxychloroquine (200 m/day). DiscussionThe combination of MG and SLE poses clinical challenges due to the potential for confusion.Both conditions are common in women and both are accompanied by the presence of antinuclear antibody.MG is an organ-selective antibody directed against acetylcholine receptors, while SLE attacks multiple organs and elicits various antibodies, mainly against nuclear antigens and double-stranded DNA.Studies show that people with MG also have an increased likelihood of experiencing severe clinical manifestations of SLE.The most common signs of lupus are polyarthritis and polyarthralgia, while other common symptoms include rash, fever, and pleurisy.Most people with myasthenia gravis require immunosuppressants to achieve treatment goals of full physical function or a relatively good quality of life.8% of MG patients had SLE disease that is mean the prevalence of SLE in MG Patients was higher than general population. ConclusionA literature review revealed 11 cases of SLE/MG overlap described in seven publications from 2012 to 2022.This study suggests that SLE should be suspected in any MG patients with polyarthritis.Further studies are needed to better understand the connection between SLE and MG disorders.