Myasthenia And HIV Infection: An Unusual Combination, One Case Report In Abidjan, Ivory Coast

Abstract

Introduction: The co-occurrence of autoimmune myasthenia gravis and HIV infection is poorly documented. Existing cases of combination myasthenia gravis and HIV are often associated with immune reconstitution inflammatory syndrome (IRIS), whereas the onset of myasthenia gravis prior to HIV diagnosis is exceptional. Observation: We report the case of a 43-year-old woman with seronegative generalized myasthenia gravis since 2002, 23 years before presentation, diagnosed with HIV-1 infection in 2009, 16 years before presentation. She was virologically stable on triple antiretroviral therapy (CD4 = 993/mm³, undetectable viral load). Electroneuromyography showed a 25% decremental response on repetitive nerve stimulation. Anti-AChR antibodies were negative; MuSK and LRP4 were not tested. During a myasthenic crisis with respiratory distress and muscarinic features, pyridostigmine was stopped and resuscitation measures were undertaken. Subsequent corticosteroid and azathioprine therapy led to marked improvement (Garches score 55 → 85 after 8 months). Conclusion: This rare case of myasthenia preceding HIV diagnosis illustrates an association independent of IRIS. It suggests that immunosuppressive therapy can be used safely in well-controlled HIV infection under close virological and immunological monitoring within a multidisciplinary framework.