Clinical Neurology and Neuroscience

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Occurrence of Biermer's Disease After 8 Years of Follow-Up of Myasthenia Gravis: About a Clinical Case

Received: 19 January 2017    Accepted: 09 February 2017    Published: 01 March 2017
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Abstract

The auto immune myasthenia comorbidity and Biermer disease is less documented and rarely brought in the literature. We bring back the observation of a Senegalese patient hospitalized in our department of Neurology at Fann hospital (Dakar). It concerned a patient aged 58 years followed up for auto-immune myasthenia to antibodies anti-receptors of acetylcholine Ac RACH since 8 years and having a benefit of recurrent blood transfusion with a blood group A rhesus positive. He was received on neurologic consultation for a tiredness associated to an effort dyspnea and a gastro esophageal reflux accompanied by vomiting. The interrogatory found palpitations which necessitated a hospitalization two month before. Physical examination had objective a myasthenia syndrome, an anemic syndrome on the other hand, sub icteric mucosa’s were noted but no melanodermia no glossite. The rest of the physical examination was without particularity. The diagnoses of the Biermer illness was carried out in front of the anemic syndrome, the chronicity of the symptomatology without notion of fluctuation and the complementary exams having as objective a low rate of hemoglobin and a deficit in vitamin B12. The origin auto-immune of this anemia was confirmed by the immunologic test which had put in evidence a high rate of anti-bodies anti- intrinsic factor. The patient benefited from a blood transfusion then a treatment from cobalamin (for life) was also installed associated to a symptomatic management of the patient. The evolution after 6 weeks of the treatment was favorable with a complete regression of the dyspnea, vomiting and the attenuation of the effort tiredness. Myasthenia gravis and Biermer disease comorbidity has to be discussed in front of every myasthenia patient presenting clinical signs of effort dyspnea to a chronic anemia because early diagnoses of this association of Biermer illness and myasthenia gravis favors a better prognosis and not to progress to the combined degeneration of the spinal cord. The autoimmune substratum of the mechanism of this comorbidity remains to be elucidated but in all cases multidisciplinary management is necessary.

DOI 10.11648/j.cnn.20170101.12
Published in Clinical Neurology and Neuroscience (Volume 1, Issue 1, February 2017)
Page(s) 5-7
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Myasthenia, Biermer’s Disease, Comorbidity, Senegal

References
[1] Toh, B. H., van Driel, I. R., & Gleeson, P. A. (1997). Pernicious anemia. New England Journal of Medicine, 337 (20), 1441-1448.
[2] Hoffman R, Benz EJ, Siberstein LE, et al. Hematology: Basic principles and practice 6st edition. Elsevier, 2013.
[3] Briani C, Dalla Torre C, Citton V, et al. Cobalamin deficiency: clinical picture and radiological findings. Nutrients 2013; 5: 4521-4539.
[4] J. Dewulf, A. Dermine, J.-P. Defour, M.-C. Vekemans. Une anémie de Biermer se dissimulant sous les traits d'une anémie normocytaire. Louvain médical 2015: 381–388.
[5] Humbert P, Dupond J. Syndromes auto-immuns multiples. Ann Med Interne 1988;139: 159-68.
[6] Whittingham S, Mackay IR. Pernicious anemia and gastric atrophy. In: Rose NR, Mackay IR, eds. The autoimmune diseases. Orlando, Fla.: Academic Press, 1985: 243-66.
[7] Loukili NH, Noel E, Blaison G, Goichot G, Kaltenbach G, Rondeau M et al. Update of pernicious anemia. A retrospective study of 49 cases. Rev Med Int 2004;25: 556-61.
[8] Boubacar S, Diagne NS, Adji DB, Fogang YF, Maiga Y, et al. (2016) Myasthenia Gravis Associated with Diabetes about an Observation in Dakar, Senegal (West Africa) and Review of the Literature. Adv Mol Diag 1: 101.
[9] Juillet (2015) Protocole National de Diagnostic et de Soins (PNDS) Myasthénie autoimmune. Centre de références de pathologie neuromusculaire Paris Est.
[10] Robertson N, Deans J, Compston D. Myasthenia gravis: a population based epidemiological study in Cambridgeshire, England. J Neurol Neurosurg Psychiatry. 1998; 65: 492-6.
[11] A. Boughammoura-Bouatay, S. Chebel,S. Younes-Mhenni, M. Frih-Ayed. NPG Neurologie - Psychiatrie - Gériatrie (2008) 8, 21—24.
[12] Kanazawa M, Shimohata T, Tanaka K, Nishizawa M. Clinical features of patients with myasthenia gravis associated with auto-immune diseases. Eur J Neurol 2007;14: 1403-4.
[13] http://dx.doi.org/10.1016/j.revmed.2012.10.162.
[14] Lindenbaum J, Rosenberg IH, Wilson PWF, Stabler SP, Allen RH. Prevalence of cobalamin deficiency in the Framingham elderly population. Am J Clin Nutr 1994;60: 2-11.
[15] Simpson JA. Myasthenia gravis: new hypothesis. Scot Med J 1960;5: 419-39.
[16] Howard FM, Silverstein MN, Mulder DW. The coexistence of myasthenia gravis and pernicious anemia. Am J Med Sci 1965;250: 518-26.
[17] Chang KH, Lyu RK, Ro LS, Wu YR, Chen CM. Coexistence of pernicious anemia and myasthenia gravis. A rare combination of auto-immune diseases in Taiwan. J Formos Med Assoc 2006;105: 946-9.
[18] Zittoun J, Tulliez M, Estournet B, Goulon M. Humoral and cellular immunity to intrinsec factor in myasthenia gravis. Scand J Haematol 1979;23: 442-8.
[19] Andrès E, Noel E, Maloisel F. Hematological findings in the syndrome of food-cobalamin malabsorption. Am J Med 2003;115: 592.
[20] Grunenberger F, et al. JL. The syndrome of food-cobalamin malabsorption revisited in a Department of Internal Medicine. A monocentric cohort study of 80 patients. Eur J Intern Med 2003;14: 221–6.
[21] E. Andrès et al. Carences en vitamine B12 chez l’adulte: étiologies, manifestations cliniques et traitement. La revue de médecine interne 26 (2005) 938–946.
Author Information
  • Department of Neurology, Fann National Teaching Hospital, Dakar, Senegal

  • Department of Neurology, Fann National Teaching Hospital, Dakar, Senegal

  • Department of Neurology, Fann National Teaching Hospital, Dakar, Senegal

  • Department of Neurology, Fann National Teaching Hospital, Dakar, Senegal

  • Department of Neurology, Fann National Teaching Hospital, Dakar, Senegal

  • Department of Neurology, Fann National Teaching Hospital, Dakar, Senegal

  • Department of Neurology, Fann National Teaching Hospital, Dakar, Senegal

  • Department of Neurology, Fann National Teaching Hospital, Dakar, Senegal

  • Department of Neurology, Fann National Teaching Hospital, Dakar, Senegal

  • Department of Neurology, Fann National Teaching Hospital, Dakar, Senegal; Department of Internal Medicine, Hospital of Pikine, Dakar, Senegal

  • Department of Neurology, Fann National Teaching Hospital, Dakar, Senegal

  • Department of Neurology, Fann National Teaching Hospital, Dakar, Senegal

  • Department of Neurology, Fann National Teaching Hospital, Dakar, Senegal

  • Faculty of Health Sciences, Abdou Moumouni University, Niamey, Niger

  • Department of Neurology, Gabriel Touré University Hospital, Bamako, Mali

  • Department of Neurology, Fann National Teaching Hospital, Dakar, Senegal

  • Department of Neurology, Fann National Teaching Hospital, Dakar, Senegal

  • Department of Neurology, Fann National Teaching Hospital, Dakar, Senegal

  • Department of Neurology, Fann National Teaching Hospital, Dakar, Senegal

  • Department of Neurology, Fann National Teaching Hospital, Dakar, Senegal

Cite This Article
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    Soumaila Boubacar, Ngor Side Diagne, Eric Gueumekane Lamou Bila, Christian Madjirabe Ngarndiguina, Ibrahima Mariam Diallo, et al. (2017). Occurrence of Biermer's Disease After 8 Years of Follow-Up of Myasthenia Gravis: About a Clinical Case. Clinical Neurology and Neuroscience, 1(1), 5-7. https://doi.org/10.11648/j.cnn.20170101.12

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    ACS Style

    Soumaila Boubacar; Ngor Side Diagne; Eric Gueumekane Lamou Bila; Christian Madjirabe Ngarndiguina; Ibrahima Mariam Diallo, et al. Occurrence of Biermer's Disease After 8 Years of Follow-Up of Myasthenia Gravis: About a Clinical Case. Clin. Neurol. Neurosci. 2017, 1(1), 5-7. doi: 10.11648/j.cnn.20170101.12

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    AMA Style

    Soumaila Boubacar, Ngor Side Diagne, Eric Gueumekane Lamou Bila, Christian Madjirabe Ngarndiguina, Ibrahima Mariam Diallo, et al. Occurrence of Biermer's Disease After 8 Years of Follow-Up of Myasthenia Gravis: About a Clinical Case. Clin Neurol Neurosci. 2017;1(1):5-7. doi: 10.11648/j.cnn.20170101.12

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  • @article{10.11648/j.cnn.20170101.12,
      author = {Soumaila Boubacar and Ngor Side Diagne and Eric Gueumekane Lamou Bila and Christian Madjirabe Ngarndiguina and Ibrahima Mariam Diallo and Patrice Ntenga and Ousmane Cisse and Alassane Mamadou Diop and Ndiaga Matar Gaye and Maouly Fall and Marième Soda Diop and Anna Modji Basse and Adjaratou Dieynabou Sow and Hamid Assadeck and Youssoufa Maiga and Lala Bouna Seck and Kamadore Touré and Moustapha Ndiaye and Amadou Gallo Diop and Mouhamadou Mansour Ndiaye},
      title = {Occurrence of Biermer's Disease After 8 Years of Follow-Up of Myasthenia Gravis: About a Clinical Case},
      journal = {Clinical Neurology and Neuroscience},
      volume = {1},
      number = {1},
      pages = {5-7},
      doi = {10.11648/j.cnn.20170101.12},
      url = {https://doi.org/10.11648/j.cnn.20170101.12},
      eprint = {https://download.sciencepg.com/pdf/10.11648.j.cnn.20170101.12},
      abstract = {The auto immune myasthenia comorbidity and Biermer disease is less documented and rarely brought in the literature. We bring back the observation of a Senegalese patient hospitalized in our department of Neurology at Fann hospital (Dakar). It concerned a patient aged 58 years followed up for auto-immune myasthenia to antibodies anti-receptors of acetylcholine Ac RACH since 8 years and having a benefit of recurrent blood transfusion with a blood group A rhesus positive. He was received on neurologic consultation for a tiredness associated to an effort dyspnea and a gastro esophageal reflux accompanied by vomiting. The interrogatory found palpitations which necessitated a hospitalization two month before. Physical examination had objective a myasthenia syndrome, an anemic syndrome on the other hand, sub icteric mucosa’s were noted but no melanodermia no glossite. The rest of the physical examination was without particularity. The diagnoses of the Biermer illness was carried out in front of the anemic syndrome, the chronicity of the symptomatology without notion of fluctuation and the complementary exams having as objective a low rate of hemoglobin and a deficit in vitamin B12. The origin auto-immune of this anemia was confirmed by the immunologic test which had put in evidence a high rate of anti-bodies anti- intrinsic factor. The patient benefited from a blood transfusion then a treatment from cobalamin (for life) was also installed associated to a symptomatic management of the patient. The evolution after 6 weeks of the treatment was favorable with a complete regression of the dyspnea, vomiting and the attenuation of the effort tiredness. Myasthenia gravis and Biermer disease comorbidity has to be discussed in front of every myasthenia patient presenting clinical signs of effort dyspnea to a chronic anemia because early diagnoses of this association of Biermer illness and myasthenia gravis favors a better prognosis and not to progress to the combined degeneration of the spinal cord. The autoimmune substratum of the mechanism of this comorbidity remains to be elucidated but in all cases multidisciplinary management is necessary.},
     year = {2017}
    }
    

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