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Unique association of anti-GABAA receptor encephalitis and myasthenia gravis in a patient with type A thymoma

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Abstract

Association between anti-GABAAR encephalitis and myasthenia gravis is extremely rare with few reported cases. Herein, we report a case of a female patient diagnosed with anti-GABAAR encephalitis and thymoma at the first admission. She was administered glucocorticoids for long-term immunotherapy, and thymectomy with biopsy demonstrated a type A thymoma. After 4 months, the symptoms of encephalitis were relieved, but she then developed post-thymectomy myasthenia gravis with anti-AChR and anti-titin dual positivity. Antibodies to connective tissue (anti-ANA, anti-PCNA) and those characteristics of paraneoplastic syndrome (anti-Ma2/Ta) were also positive. She received oral glucocorticoids and tacrolimus as immunosuppressive therapy, and myasthenic symptoms were stable during a 2-year follow-up. Our case revealed that anti-GABAAR encephalitis and myasthenia gravis can appear in patient with type A thymoma at different periods, which alerts physicians to take long-term follow-up for anti-GABAAR encephalitis with thymoma, even after thymectomy. Concurrent positivity for more than one antibody after thymectomy is rarely observed, and their contribution to the clinical course and treatment decision remains to be further investigated.

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The original contributions of this study are included in the article and Supplementary Material. Further inquiries can be directed to the corresponding author.

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Funding

This study was supported by grants from the Natural Science Foundation of Hunan Province (Grant Numbers: 2022JJ40724, 2023JJ30062, and 2023JJ30868), Key Research and Development Program in Hunan Province (Grant Number: 2023SK2019), Science and Technology Innovation Guidance Project of Hunan Province (Grant Number: 2020SK53009), and the Changsha Municipal Natural Science Foundation (Grant Number: kq2007037).

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Authors and Affiliations

  1. Department of Neurology, The Affiliated Changsha Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, People’s Republic of China

    Song Ouyang & Hong Tan

  2. The “Double-First Class” Application Characteristic Discipline of Hunan Province (Clinical Medicine), Changsha Medical University, Changsha, Hunan, People’s Republic of China

    Song Ouyang & Weifan Yin

  3. Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, People’s Republic of China

    Xiaomei Wu, Qiong Zhan, Wei Lu & Weifan Yin

  4. Department of Pathology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China

    Feng Wu

  5. Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China

    Weiwei Duan, Qiuming Zeng & Wenping Gu

Authors
  1. Song Ouyang
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  2. Xiaomei Wu
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  9. Wei Lu
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  10. Weifan Yin
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Contributions

SO and WY drafted the original manuscript and funded this study. XM, FW, and QZ participated in the data collection and analysis. HT, WL, and WP performed the data analysis and interpretation. WD and QZ assisted with the literature review. All authors have read the final manuscript and approved the submitted version.

Corresponding author

Correspondence to Weifan Yin.

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Ethics statement

The studies involving human participants were reviewed and approved by the Medical Ethics Committee of the Second Xiangya Hospital Central South University. We have obtained written informed consent from the study participant. All of the procedures were performed in accordance with the Declaration of Helsinki and relevant policies in China. Human participants and/or animals were not involved in this research.

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The authors declare that this research was conducted in the absence of any commercial or financial relationships that could be considered a potential conflict of interest.

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Ouyang, S., Wu, X., Zhan, Q. et al. Unique association of anti-GABAA receptor encephalitis and myasthenia gravis in a patient with type A thymoma. Neurol Sci 45, 2203–2209 (2024). https://doi.org/10.1007/s10072-023-07239-0

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