SciELO - Scientific Electronic Library Online

 
vol.51 issue4Parkinsonism induced by flunarizine: case reportDiabetes insipidus following head injury: ease report author indexsubject indexarticles search
Home Pagealphabetic serial listing  

Services on Demand

Journal

Article

Indicators

Related links

Share


Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282X

Arq. Neuro-Psiquiatr. vol.51 no.4 São Paulo Nov. 1993

http://dx.doi.org/10.1590/S0004-282X1993000400023 

Esclerodermia, tireoidite e miastenia grave: estudo de um caso

 

Scleroderma, thyroiditis and myasthenia gravis: case report

 

 

Antonio L. dos Santos Werneck; Tamara Checcacci-Balod; Graça Tuma

Estudo realizado no Serviço de Neurologia do Hospital Central do Instituto de Assistência aos Servidores do Estado do Rio de Janeiro (HC/IASERJ)

 

 


RESUMO

Uma paciente de 36 anos com miastenia grave desenvolveu após dois anos intolerância ao frio, o que conduziu ao diagnóstico de tireoidite de Hashimoto. Quatro anos mais tarde apresentou pele espessada nas mãos (esclerodermia limitada). O quadro clínico e os exames complementares encaminharam o diagnóstico para a forma CREST de esclerodermia sistêmica progressiva. Discute-se a dificuldade diagnóstica da esclerodermia, assim como suas síndromes de superposição. Doença de Hashimoto e miastenia grave constituem associação pouco frequente. A presença de esclerodermia e miastenia grave é rara. Não encontramos na literatura a coincidência destas três doenças.

Palavras-chave: miastenia grave, tireoidite, esclerodermia.


SUMMARY

A thirty-six years old woman with myasthenia gravis developed cold intolerance after two years, and Hashimoto's thryroiditis diagnosis was established. Four years later she exhibited skin thickening (limited scleroderma). Laboratory and clinical findings suggested the CREST type of systemic sclerosis. Difficulty in scleroderma diagnosis is discussed, as overlap of syndromes. Hashimoto's thyroiditis and myasthenia gravis are infrequently associated. Occurrence of scleroderma and myasthenia gravis in the same patient is rare. The coincidence of these three disorders was not found in literature.

Key words: myasthenia gravis, thyroiditis, scleroderma.


 

 

Full text available only in PDF format.

Texto completo disponível apenas em PDF.

 

 

Agradecimento — Nossos agradecimentos à Dra. Eliane Francine Simon, do Serviço de Anatomia Patológica do HC/IASERJ.

 

REFERÊNCIAS

1. Aarli JA, Thunold S, Heiman P. Thyroiditis in myasthenia gravis. Acta Neurol 1978, 58:121-127.         [ Links ]

2. Assis JD. Miastenia Grave. São Paulo : Sarvier, 1990, p 18-19.         [ Links ]

3. Becker KI, Titus JH, McConahey WM, Woolner LB. Morphologic evidence of thyroiditis in myasthenia gravis. JAMA 1964, 187:994-996.         [ Links ]

4. Bennett RM. Scleroderma overlap syndromes; Rheum Clin North Am 1990, 16:185-197.         [ Links ]

5. Cattogio LJ, Bernstein RM, Black CM. Serological markers in progressive systemic sclerosis: clinical correlations. Clin Rheum Dis 1983, 42:23-25.         [ Links ]

6. Chorzelski TP, Jablonska S, Beutner EH. Anticentromere antibody: an imunological marker of a subset of systemic sclerosis. Br J Dermatol 1985, 119:381-389.         [ Links ]

7. Fritzler MJ, Klinselle TD, Garbutt E. The CREST syndrome: a distinct serologic entity with anticentromer antibodies. Am J Med 1980, 69:520-526.         [ Links ]

8. Goulon M, Estournet B, Tulliez M. Myasthenia gravis and associated diseases. Internat J Neurol 1980, 14:61-72.         [ Links ]

9. Kallenberg CGM. Early detection of connective tissue diseases in patients with Raynaud's phenomenon. Rheum Dis Clin North Am 1990, 16:11-30.         [ Links ]

10. Kleinsmith DM, Heinzerling RH, Burnham TK. Antinuclear antibodies as immunologic markers for a benign subset and different clinical characteristics of scleroderma. Arch Dermatol 1982, 118:882-886.         [ Links ]

11. McCarty GA, Rice JR, Bembe HL. Anticentromere antibody: clinical correlations and association with favorable prognosis in patients with scleroderma variants. Arthr Rheum 1983, 26:1-7.         [ Links ]

12. Marchiori PE, Scaff M, Cossermelli W, Assis JL. Miastenia grave induzida por D-penici-lamina em pacientes com esclerose sistêmica progressiva. Arq Neuropsiquiatr 1984, 42: 380-383.         [ Links ]

13. Mitchell GW, Lichteufeld PA, McDonald CJ. Myasthenia gravis and scleroderma. JAMA 1975, 233:531.         [ Links ]

15. Monden Y, Uyama T, NekaHara K. Clinical characteristics and prognosis of myasthenia gravis with other autoimmune diseases. Ann Thorac Surg 1986, 41:189-192.         [ Links ]

15. Murray-Lyon IM, Thompson RPH. Scleroderma and primary biliary cirrhosis. Br Med J 1970, 3:250-259.         [ Links ]

16. Russel AS, Lindstrom JM. Penicillamine induced myasthenia gravis associated with antibodies to acetylcoline receptors. Neurology 1978, 28:847-849.         [ Links ]

17. Scherbaum WA, Schumm F, Maisch B. Myasthenia gravis: overlap with poliendocrine autoimmunity. Klin Wochenschr 1S83, 61:509-515.         [ Links ]

18. Schoenfeld Y, Schwartz RS. Imunnology and genetic factors in autoimune diseases. N Engl J Med 1984, 311:1019-1029.         [ Links ]

19. Steen VD, Medsger TA. Epidemiology and natural history of systemic sclerosis. Rheum Dis Clin North Am 1990, 16:1-10.         [ Links ]

20. Steen VD, Ziegler GI, Rodnam GP. Clinical and laboratorial associations of anticentromere antibody in patients with progressive systemic sclerosis. Arthr Rheum 1984, 27: 125-129.         [ Links ]

21. Thorlacius S, Aarli JA, Matrer Johnsen HJ. Associated disorders in myasthenia gravis: autoimmune diseases and their relations to thymectomy. Acta Neurol Scand 1989, 80: 290-295.         [ Links ]

22. Torres FC, Grigss RC, Baum J, Penn SA. D-penicillamine induced myasthenia gravis in progressive systemic sclerosis. Arthr Rheum 1980, 23:505-508.         [ Links ]

23. Tuma F. Marcadores sorológicos na esclerose sistêmica. Tese. Faculdade de Medicina da Universidade do Rio de Janeiro. Rio de Janeiro, 1985, p 70-71.         [ Links ]

24. Vayssairat M, Fiessinger JN, Housset E. Phénomène de Raynaud: étude progressive de 100 cas. Nouv Presse Med 1979, 8:2177-2180.         [ Links ]

25. Vincent A, Newson Davis J. Acetylcholine receptor antibodies in D-penicilamine associated myasthenia gravis. Lancet 1978, 1:1246.         [ Links ]

26. Wild W, Beetham WP. Erosive arthropaty in systemic scleroderma. JAMA 1975, 232: 511-512.         [ Links ]

27. Willerson JT, Thompon RH, Hookman P. Reserpine in Raynaud's disease and phenomenon. Ann Intern Med 1970, 72:17-27.         [ Links ]

 

 

Aceite: 17-março-1993.

 

 

Dr. Antonio Luiz dos Santos Werneck — Rua João de Barros 137 apto. 601 - 22441-100 Rio de Janeiro RJ - Brasil.

Creative Commons License All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License