- |||||||||| Clinical, Review, Journal: Gut Microbiota as Regulators of Th17/Treg Balance in Patients With Myasthenia Gravis. (Pubmed Central) - Mar 1, 2022
In this review, we initially review the association between Treg/Th17 and the occurrence of MG and subsequently focus on recent findings on alterations of gut microbiota and microbial metabolites in patients with MG. We also explore the effects of gut microbiota on Th17/Treg balance in patients with MG, which may provide a new direction for the prevention and treatment of this disease.
- |||||||||| prednisone / Generic mfg.
Clinical, Journal: Antibodies to Full-Length Agrin Protein in Chinese Patients With Myasthenia Gravis. (Pubmed Central) - Feb 26, 2022
The patients usually presented weakness in the ocular, bulbar, and limb muscles, which may be combined with thymoma. These patients have more severe diseases, although the combination of pyridostigmine and prednisone was usually effective in relieving symptoms.
- |||||||||| Sleep Disorders in Myasthenia Gravis (Concourse / Mezzanine) - Feb 26, 2022 - Abstract #WSS2022WSS_92;
In this patient, oropharyngeal weakness associated with MG may have worsened the preexisting OSA syndrome. Furthermore, the respiratory muscle dysfunction that characterizes MG may have contributed to sleep hypoventilation to the point of requiring assisted ventilation.Additionally, it is important to highlight the possible role of OSA in modulating the immune system, especially considering that MG is an AD.
- |||||||||| Review, Journal: The Role of IgG4 in Autoimmunity and Rheumatic Diseases. (Pubmed Central) - Feb 25, 2022
The role of this immunoglobulin in cholangiocarcinoma is also considered as possible. The aim of this review article is to discuss the current knowledge of IgG4 not only from the perspective of the IgG4-RD but also from a point of view of other autoimmune diseases with particular emphasis on rheumatic diseases.
- |||||||||| Journal: Structural and functional brain alterations in patients with myasthenia gravis. (Pubmed Central) - Feb 25, 2022
Furthermore, deficits in somatosensory-related spatial orientation could be associated with the lower volumes in the inferior parietal lobe. Future research is needed to replicate these findings independently in a larger sample and to investigate the underlying mechanisms in more detail.
- |||||||||| Retrospective data, Journal: Thymectomy for myasthenia gravis: A pathological analysis. (Pubmed Central) - Feb 24, 2022
Follicular hyperplasia and thymomas were seen in 6 and 36 patients, respectively. The thymectomies performed in patients of MG had a fairly variable spectrum on histology; the thymic tumors were predominantly of the cortical phenotype.
- |||||||||| cyclosporine / Generic mfg.
Clinical, Journal: Risk factors for potential drug-drug interactions in patients with myasthenia gravis. (Pubmed Central) - Feb 23, 2022
Dyspnea, generalized form of MG, diabetes mellitus, hypertension, total number of drugs-used, use of antiplatelets were identified as the relevant risk factors for total number of pDDIs (R2 = 0.626,F = 73.797, p < 0.001), while age of patients and history of cancer were inversely correlated with such an outcome. The frequency of the pDDIs in hospitalized MG patients is high, and adversely influenced by dyspnea, generalized MG, diabetes mellitus, hypertension, total number of drugs-used and use of antiplatelets.
- |||||||||| Journal, Checkpoint inhibition: How to diagnose and manage neurological toxicities of immune checkpoint inhibitors: an update. (Pubmed Central) - Feb 23, 2022
Central nervous system disorders (CNS) are less frequent and are more often associated with lung cancer, and some of them (especially those with limbic encephalitis and positive onconeural antibodies) have a poor prognosis. Herein, we provide an update of the recent advances in the diagnosis and treatment of neurological toxicities related to ICI use, focusing on the exclusion of alternative diagnoses, diagnostic specificities, and treatment of n-irAEs.
- |||||||||| Journal: Thymolipoma and its Association with Myasthenia Gravis: a Multi-center Experience. (Pubmed Central) - Feb 23, 2022
Although the effect of using steroids in myasthenic patients on thymolipomic transformation still needs confirmation, diagnosis of thymolipoma should be kept in mind in myasthenic patients presenting with relevant symptoms and taking steroids. Furthermore, complete remission of myasthenic symptoms after removal of thymolipoma needs further investigation.
- |||||||||| Hizentra (human immune globulin subcutaneous 20%) / CSL Behring, HyQvia (immune globulin infusion 10% (human) with recombinant human hyaluronidase) / Halozyme, Takeda, Rituxan (rituximab) / Biogen, Zenyaku Kogyo, Roche
Treatment of myelin oligodendrocyte glycoprotein antibody associated disease with subcutaneous immune globulin (Virtual Poster Hall) - Feb 20, 2022 - Abstract #ACTRIMSForum2022ACTRIMS_Forum_384;
Notably, these findings are in line with reports in other autoimmune neurological diseases, including autoimmune peripheral neuropathies and myasthenia gravis, in which SCIG appears to exhibit similar efficacy to IVIG, with potential reductions in systemic adverse effects. Our findings support the rationale for prospective randomized studies investigating the efficacy of SCIG for relapse prevention in MOGAD.
- |||||||||| Massive Football-Sized Thymoma in a Previously Healthy 44-Year-Old Man (Room 207-208 (South Building, Level 2), Moscone Center) - Feb 19, 2022 - Abstract #ATS2022ATS_6183;
Surgical resection is the mainstay therapy, with chemotherapy and radiation therapy providing favorable results on prognosis depending on resectability. Clinicians should be aware of this rare occurrence so as to facility a proper multidisciplinary approach to management.
- |||||||||| Unilateral Upper Extremity Thrombosis with Typical Chest Pain as the First Presentation of Metastatic Necrotic Thymoma (Area I, Hall F (North Building, Exhibition Level), Moscone Center) - Feb 19, 2022 - Abstract #ATS2022ATS_5057;
She received radiotherapy along with Cisplatin, Adriamycin, and Cytoxan chemotherapy with a good response seen on imaging...The patient had a history of autoimmune hemolytic anemia which could have been investigated in-depth and could have led to the diagnosis of thymoma before it could metastasize. The other interesting finding was that the thymoma was necrotic, and thymomas are usually well-circumscribed and non-necrotic.
- |||||||||| Rituxan (rituximab) / Biogen, Zenyaku Kogyo, Roche
Severe Obstructive Sleep Apnea in an Adolescent with Hypernasality, Dysarthria and Muscle Weakness (Area B, Hall F (North Building, Exhibition Level), Moscone Center) - Feb 19, 2022 - Abstract #ATS2022ATS_4684;
Patient received plasmapheresis 5 times and Rituximab first dose was given...Diagnosis of such children may require a high index of suspicion due to the undulant clinical features and absences of AchR-Abs. Acetylcholinesterase inhibitors, plasma exchange, immunosuppression, and NIV was required to effectively improve MG, and resolve OSA and hypoventilation.
- |||||||||| A Life Re-Imagined: A Case for Newborn Screen? (Area B, Hall F (North Building, Exhibition Level), Moscone Center) - Feb 19, 2022 - Abstract #ATS2022ATS_4666;
Successful treatment of CMS requires life-altering medications. A focused panel should be included in newborn screening.
- |||||||||| hydroxyurea / Generic mfg., azathioprine / Generic mfg.
Simultaneous Blast and Myasthenic Crises Requiring Concomitant Plasma- and Leukapheresis (Area A, Hall F (North Building, Exhibition Level), Moscone Center) - Feb 19, 2022 - Abstract #ATS2022ATS_4505;
While it is understood that maintenance immunosuppression MG patients receive increases their risk for infection, agents like azathioprine can cause hematologic complications and leukemia...She was admitted to the hematologic service and started on hydroxyurea...A multi-disciplinary collaboration was used to design a circuit to implement concomitant plasmapheresis, leukapheresis, and CRRT in the hopes of providing life-saving therapies. While this patient did not benefit from this plan, it should remain a consideration for other patients with MG whose immunosuppressive therapies may put the patient at risk for leukemias.
- |||||||||| Opdivo (nivolumab) / Ono Pharma, BMS, Rituxan (rituximab) / Biogen, Zenyaku Kogyo, Roche, Yervoy (ipilimumab) / Ono Pharma, BMS
Immune Checkpoint Inhibitor Related Auto Immune Demyelinating Polyneuropathy (Area A, Hall F (North Building, Exhibition Level), Moscone Center) - Feb 19, 2022 - Abstract #ATS2022ATS_4504;
Case An 86-year-old male with history of renal cell carcinoma (RCC) with spinal metastasis status-post nephrectomy, Von Hippel-Lindau, stroke, coronary artery disease, and hypertension, presented to veteran affairs medical center with bilateral diplopia, ptosis, dysarthria, and ophthalmoplegia 10 days after starting checkpoint inhibitors nivolumab and ipilimumab for RCC...He was started on rituximab infusion outpatient with continued improvement in symptoms...Healthcare practitioners should also be aware of the importance of a multidisciplinary approach and vigorous multimodal therapy. In addition to the usual diagnostic tests, the diagnostic programs should incorporate the evaluation of additional organ systems such as the dermatological, gastrointestinal, respiratory, neuromuscular, and cardiovascular systems.
- |||||||||| What's Abuzz? Encephalopathy in a Transplant Recipient (Area J, Hall F (North Building, Exhibition Level), Moscone Center) - Feb 19, 2022 - Abstract #ATS2022ATS_4486;
He was on fluconazole for coccidioidomycosis prophylaxis...He was started on empiric meningitis treatment with ampicillin, vancomycin, cefepime, and acyclovir, and was given doxycycline for atypical coverage...The second is management of a critically ill patient with meningitis and myasthenia gravis, since multiple agents for empiric therapy have been associated with worsening of or precipitating myasthenic crisis. Finally, supportive care is the mainstay of the management of WNV encephalitis and IVIG and adjustments in immunosuppression is controversial.
- |||||||||| Tagrisso (osimertinib) / AstraZeneca
Osimertinib Induced Cardiotoxicity-Two Case Reports (Area D, Hall F (North Building, Exhibition Level), Moscone Center) - Feb 19, 2022 - Abstract #ATS2022ATS_3301;
Here we report two cases of TKI associated adverse events which reversed with medical management, similar to myocardial injury observed with HER2 directed therapy. Conclusion These cases will add to literature to characterize cardiotoxicity associated with Osimertinib.
- |||||||||| Keytruda (pembrolizumab) / Merck (MSD)
A Case of Pembrolizumab-Induced Myasthenia Gravis in a Patient with Squamous Cell Lung Carcinoma (Area D, Hall F (North Building, Exhibition Level), Moscone Center) - Feb 19, 2022 - Abstract #ATS2022ATS_3299;
In our case, signs of immune-related side effects were present via labs and history, but his dyspnea and fatigue were confounded by underlying COPD and severe malnutrition. Bulbar weakness proved to be a late feature, and diagnosis was only presumed and treated following worsening diaphragmatic dysfunction.ConclusionEarly consideration of myasthenia gravis in patients on immune checkpoint inhibitors who present with dyspnea or myalgias may prompt earlier treatment and potential prevention or attenuation of myasthenic crisis.*Note: C. Nemeh & C. Wayant contributed equally to this submission
- |||||||||| Soliris (eculizumab) / AstraZeneca
A Rare Non-Pulmonary Autoimmune Intrathoracic Complication of SARS-CoV-2 Infection (Room 3016/3018 (West Building, Level 3), Moscone Center) - Feb 19, 2022 - Abstract #ATS2022ATS_2396;
Initially, the patient was treated with intravenous immunoglobulin and eculizumab for presumed myasthenic crisis; however, obtundation persisted...Aggressive surgical treatment in the setting of acute SARS-CoV-2 infection is indicated for this life-threatening condition. Further investigation into the molecular mechanism of SARS-CoV-2 induction of this deadly autoimmune response is warranted.
- |||||||||| rivaroxaban / Generic mfg., apixaban / Generic mfg.
Pulmonary Embolism in a Patient with Ocular Myasthenia (Area B, Hall F (North Building, Exhibition Level), Moscone Center) - Feb 19, 2022 - Abstract #ATS2022ATS_1448;
Diabetes, Hypertension, Dyslipidemia and myasthenia being an autoimmune disease may increase the risk of PE in the patient. There are one or two case reports where there is development of ocular myasthenia after treatment with oral Rivaroxaban for PE but almost no literature or case reports on development of PE in a treated case of ocular myasthenia to our knowledge.
- |||||||||| Keytruda (pembrolizumab) / Merck (MSD)
Pembrolizumab Induced Encephalitis; Catching Diagnosis Early Is the Key (Area G, Hall F (North Building, Exhibition Level), Moscone Center) - Feb 19, 2022 - Abstract #ATS2022ATS_1157;
After seizure and infectious etiologies were ruled out, started treatment with 1mg/kg of solumedrol and later increased to pulse dose steroids...Severe cases often requires permanent discontinuation of ICPI, pulse dose steroids and for refractory cases escalation of immunosuppressive treatment with IVIg, plasma exchange, rituximab, methotrexate, azathioprine and mycophenolate...Knowledge about occurrence and high degree of suspicion is important for early diagnosis. Early diagnosis is important as patients respond well with treatment.
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