Internal Medicine
CASE REPORTS
Double Seronegative Myasthenia Gravis with Anti-LRP4 Antibodies Presenting with Dropped Head and Acute Respiratory Insufficiency
Goichi BeckTaiki YabumotoKousuke BabaTsutomu SasakiOsamu HiguchiHidenori MatsuoHideki Mochizuki
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JOURNALS OPEN ACCESS

Volume 55 (2016) Issue 22 Pages 3361-3363

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Abstract

We herein report the case of a 72-year-old man demonstrating myasthenia gravis (MG) with a dropped head and acute respiratory insufficiency. There was no ocular, bulbar, or limb involvement. The patient was seronegative for anti-acetylcholine receptor (AChR) antibodies and anti-muscle-specific tyrosine kinase (MuSK) antibodies. Subsequent tests showed seropositivity for anti-low-density lipoprotein receptor-related protein 4 (LRP4) antibodies. The addition of steroid pulse therapy resulted in a full remission of his respiratory symptoms. This presentation suggests that LRP4-positive MG should be considered in the differential diagnosis of patients presenting with acute respiratory insufficiency without either cranial or limb involvement.

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© 2016 by The Japanese Society of Internal Medicine
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