Localized morphea and myasthenia gravis

LETTERS CASE NOTES Localized morphea and myasthenia gravis To the Editor: Scleroderma and myasthenia gravis have been related to several autoimmune entities. It has been suggested that such association is related to an autoimmune predisposition.1,2 A 39-year-old woman presented with a whitish, oval, indurate, skin lesion that was 7 cm in diameter and a lilac-colored ring on the trunk. Its surface was smooth and no hair was evident. A biopsy specimen confirmed the diagnosis of morphea. Laboratory results were normal. One year later, the patient re-presented with a history of malaise, muscular weakness, diplopia, blurred vision, and ptosis, especially evident in the evening. Twenty days after presentation, she manifested a severe increase in muscular weakness, permanent diplopia, dyslalia, and cardiorespiratory arrest, requiring ventilation and plasma exchange. The patient had increased titers of acetylcholine receptor antibodies in serum. Myasthenia gravis was diagnosed. She was treated with piridostigmina, 420 mg/d, and to date she is well. To our knowledge, this is the first reported case of an association between localized plaque morphea and myasthenia gravis. Only one case of linear scleroderma and myasthenia has been published.3 In our case, the morphea plaque appeared 1 year

J AM ACAD DERMATOL

before the symptoms of myasthenia gravis. This finding, contrary to other reported systemic scleroderma cases in which the dermatosis always appeared after myasthenia, is perhaps an accidental association. Further studies should be carried out to define the pathogenesis of these entities. Viviana Parra, MD Nelson Driban, MD, PhD Adriana Bassotti, MD Department of Dermatology Hospital Espan ˜ ol Dorrego, Mendoza, Argentina Correspondence to: Dr Parra at E-mail: [email protected] REFERENCES 1. Mitchell GW, Lichtenfeld PJ, McDonald CJ. Myasthenia gravis and scleroderma. An unusual combination of diseases. JAMA 1975; 233:531. 2. Bhalla R, Swedler WI, Lazarevic MB, Ajmani HS, Skosey JL. Myasthenia gravis and scleroderma. J Rheumatol 1993;20:1409-10. 3. Kim HS, Chun YS, Hann SK, Park WH. A case of linear scleroderma and myasthenia gravis. J Dermatol 2000;27:31-4.

Published online ●●● J Am Acad Dermatol 2003;49:e5 Copyright © 2003 by the American Academy of Dermatology, Inc. 0197-6787/2003/$30.00⫹0 doi:10.1067/S1090-9622(03)01121-6

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