Management of Autoimmune urticaria in a patient with Myasthenia Gravis, a challenging case

• DOI: 10.5339/qmj.2023.sqac.6
• Publication Date: 2023-05-21T09:30:27Z
• Authors: Asaad Omer Imameldin; Sami Aqel; Ahmad Shihab Alta...; Tayseer Ibrahim
• Keywords: Omalizumab; Thymectomy

Introduction: The pathophysiology of chronic spontaneous urticaria (CSU) is not yet fully understood; however, increasing evidence supports the association between CSU and autoimmunity. Myasthenia gravis (MG) an autoimmune neuromuscular disorder. MG management relies on using immunosuppressants avoiding certain medications that can precipitate crisis. coexistence was described in literature elderly patients. Herein we present a challenging case regarding young female with MG. Case report: A 22-year-old lady known to have post thymectomy, history multiple crises, presented Allergy Clinic recurrent itchy hives typical for without associated angioedema. Despite being Azathioprine low-dose steroids treatment, she had active disease, UAS7:32, UCT: 5. neurologist advised against use regular oral antihistamines because they might exacerbate Although do serum autologous skin testing, basophil activation test, or IgG autoantibodies definitive definition (aiCSU), patient has some features supporting diagnosis aiCSU (see Table 1). In addition, normal total IgE level, C3, C4, negative RF, ANA, ANCA, anti-TPO, anti-thyroglobulin antibodies. After discussion neurologist, started her Omalizumab 300 mg every four weeks, which increased 450 two weeks partial control CSU. She rituximab treat improvement Conclusion: To best our knowledge, limited data describing Moreover, there insufficient safety patients MG, are first line treatment There clinical laboratory biomarkers help identifying endotypes. Recognition endotype essential as it helps predict disease course response treatment. careful therapeutic interventions coexistent diseases warranted achieve efficacy reduce drug interactions adverse effects.