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Autumn 2019, Vol. 27 No. 3

Hong Kong J. Dermatol. Venereol. (2019) 27, 131-135


Case Report

Paraneoplastic myasthenia gravis associated with Merkel cell carcinoma

與麥克氏細胞癌相關的腫瘤附屬重症肌無力

DL Lankenau Vela, H Decanini Arcaute, F De la Garza Salazar

Abstract

Background: Merkel cell carcinoma (MCC) is an unusual primary neuroendocrine cutaneous carcinoma which may rarely may be associated with neurological paraneoplastic syndromes. Nevertheless, the coexistence of myasthenia gravis (MG) with MCC has not been previously reported. History: A 74-year-old man presented with dysphagia, tetraparesis, horizontal diplopia and right palpebral ptosis. MG was diagnosed and treatment with piridostigmine and IV immunoglobulin was given, leading to a partial response. Two weeks later, there was rapid growth of a painless left suprapatellar nodule which was compatible with MCC. Conclusion: Merkel cell carcinoma may rarely present as refractory MG. Tumour excision may be necessary for resolution of the syndrome.

背景:麥克氏細胞癌是一種罕見的原發性神經內分泌皮膚癌,罕有地可以伴隨相關的腫瘤附屬神經綜合徵。儘管如此,重症肌無力與麥克氏細胞癌的仍未有並存的病例報導。病史:一名74歲男性患者出現吞嚥困難、四肢癱瘓、水平複視和右眼瞼下垂,被診斷為重症肌無力,給予啶斯的明和靜脈注射免疫球蛋白治療後,病情得到部份改善。兩週後,左側髕上快速長出與麥克氏細胞癌吻合的無痛結節。結論:麥克氏細胞癌一病可以罕有地首現為難治的重症肌無力,腫瘤切除可能是解除該頑疾的鑰匙。

Keywords: Merkel cell carcinoma, myasthenia gravis, paraneoplastic neurological syndrome

關鍵詞: 麥克氏細胞癌、重症肌無力、腫瘤附屬神經綜合徵