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September 5, 2026BMC NeurologyOpen Access

Myasthenia gravis complicated by myocarditis associated with anti-titin and anti-VGKC antibodies: a case report

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Why the study?

Myocardial involvement in myasthenia gravis is rare but can be life-threatening and easily overlooked due to symptom overlap with myasthenic exacerbation, making early recognition of clinical and immunological features essential.

Population

74-year-old woman with myasthenia gravis complicated by myocarditis

Design

Case report

Follow-up

4-month

Key result

Intensified immunotherapy with intravenous immunoglobulin, tacrolimus, and corticosteroids led to rapid resolution of respiratory distress and normalization of cardiac biomarkers and ejection fraction.

Authors

NMNi MaoLXLei XieHHHuaiqiang Hu

Discussion

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Member takes

Overview

May warrant cardiac evaluation in MG respiratory distress; leaves open efficacy of intensified immunotherapy.

Key Points

  • To report and characterize a rare case of acute myasthenia gravis exacerbation complicated by occult autoimmune myocarditis associated with anti-titin and anti-VGKC antibodies.
  • Clinical, serological, and cardiovascular assessment of a 74-year-old female presenting with myasthenic crisis symptoms, including cardiac biomarker testing, echocardiography, coronary CTA, and antibody assays.
  • Administration of combined immunotherapy and symptomatic treatment consisting of pyridostigmine, intravenous immunoglobulin, tacrolimus, and low-dose corticosteroids, with longitudinal follow-up through 4 months.
  • Diagnostic evaluation identified elevated peak troponin I (2.19 µg/L), CK-MB (30 µg/L), and NT-proBNP (4581 ng/L), along with a depressed left ventricular ejection fraction of 42% and positive titers for AChR, titin, cardiac, and VGKC antibodies.
  • Treatment led to rapid symptom resolution, normalization of cardiac biomarkers and ejection fraction within days, and complete resolution of electrocardiographic abnormalities by the 4-month follow-up.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P
Population
A 74-year-old woman with longstanding myasthenia gravis who developed acute myocarditis during an acute exacerbation, followed for 4 months.
I
Intervention
Pyridostigmine, intravenous immunoglobulin, tacrolimus, and low-dose corticosteroids
O
Outcome
Resolution of symptoms, normalization of cardiac biomarkers and ejection fraction, and resolution of ECG changes

This case highlights the importance of considering myocarditis in myasthenia gravis patients presenting with respiratory difficulty, emphasizing the need for prompt ECG monitoring and cardiac enzyme assessment.

Limitations

  • Cardiac magnetic resonance imaging was not performed due to clinical instability.
  • Endomyocardial biopsy was not performed to histologically confirm myocarditis.
  • Single case report limits generalizability.

Cite This Study

Mao et al. (2026) conducted a case report in Myasthenia gravis complicated by myocarditis (n=1). Immunosuppressive therapy (pyridostigmine, IVIG, tacrolimus, corticosteroids) was evaluated on Clinical and cardiac recovery. Intensified immunotherapy with intravenous immunoglobulin, tacrolimus, and corticosteroids led to rapid resolution of respiratory distress and normalization of cardiac biomarkers and ejection fraction.

synapsesocial.com/papers/6a9bd3f16b95aff0620eb27ehttps://doi.org/10.1186/s12883-026-05329-y
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Cardiac manifestations of myasthenia gravis: A systematic review2014 · 60 citations
  2. 2Atrioventricular block and myastenia gravis. A case report and review of the literature2025
  3. 3Efgartigimod for the treatment of immune checkpoint inhibitor-associated myocarditis complicated with impending crisis state of myasthenia gravis: a case report2025 · 3 citations
  4. 4Case report: Efgartigimod combined with intravenous methylprednisolone in a case of co-occurrence of unexplained myasthenia gravis, inflammatory myopathy, and fulminant myocarditis2026
  5. 5Myasthenia Gravis: A Case Study Focusing on Comprehensive Nursing Management2025