Myasthenia and Antisynthetase Antibody Syndrome: A Case Report in Togo - Myasthenia and Antisynthetase Antibody Syndrome: A Case Report in Togo - Open Access Pub

Myasthenia is a rare neurological condition with risk of death in case of inappropriate management. The outcome of this pathology is very bad in developing countries with inadequate technical Platform. We underlined the main difficulties of diagnostic and the management of Myasthenie and antisynthetase antibody syndrome in a 44 years-old Togolese man. DOI10.14302/issn.2470-5020.jnrt-17-1738 Myasthenia gravis is an autoimmune disease of the neuromuscular junction 1. It is a rare condition, with an estimated prevalence between 45 and 142 per 1000 000 inhabitants, which can occur at any age, but with a clear predominance of females 2. Myasthenia gravis may in rare cases associate with other immune diseases such as Hashimoto's thyroiditis, lupus erythematosus, rheumatoid arthritis and juvenile diabetes 3. The association of myasthenia gravis with antisynthetase antibody syndrome is even more rare 4. We report here a case of this association between myasthenia gravis and anti-synthetase syndrome. Mr ATT Kos is a 44-year-old patient receiving neurological consultation for dyspnea and sensation of generalized muscle weakness worsening on exertion. The onset of the symptoms dates back to August 2005 marked by the progressive installation of a dyspnea of effort without the notion of cough or slimming. There was no associated infectious context. A consultation in pneumology made it possible to classify his dyspnea at stage I of Sadoul. After a chest radiograph that was normal, he had a thoracic CT scan that revealed multiple bubbles of bilateral emphysema. The patient was then given corticosteroids and beta 2 mimetic. The development was marked by a discreet improvement in dyspnea. The patient again consults with the persistence of dyspnea and a fatigability to the usual effort with modification of the timbre of the voice. This consultation made on December 29, 2016 had made it possible to find episodes of rare false roads as well as a ptosis in case of extreme fatigue. Clinical examination was normal. The diagnosis of myasthenia gravis was then discussed. The detection of anti-receptor anti-acetylcholine antibodies (Ac Anti RACH) was positive with a titre of 0.8 nmol / ml (normal less than 0.2 nmol / ml.) The electromyogram showed a moderate decrease in motor potential at The repetitive stimulation was of the order of 9% .The mediastinum scan showed bilateral pulmonary fibrosis (Figure 1) in relation to its progressive pulmonary pathology and a prostigmine test was performed during a fatigue episode associated with A ptosis and a marked regression of the signs