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Abstract Details

Myasthenia Gravis in Monozygotic Twins
Neuro-ophthalmology/Neuro-otology
P6 - Poster Session 6 (12:00 PM-1:00 PM)
5-002
Myasthenia gravis is known to develop from an acquired autoimmune process, however there is minimal literature available in regards to the role of inheritable factors that may make individuals more prone to develop the disease.  We found several studies identifying monozygotic twins as being acetylcholine receptor antibody positive and manifesting generalized symptoms, but found no studies detailing significant variations in disease manifestation amongst the pairs of monozygotic twins.

Provide a detailed case report of monozygotic twins with different clinical manifestations of myasthenia gravis.

N/A
This case report details a pair of monozygotic twins who were seropositive for antibodies against the acetylcholine receptor, and manifested different clinical variations of myasthenia gravis (MG). Both patients had established care with Neuro-Opthalmology, as one had a prior AION, and the other had chronic complaints of diplopia and ptosis.  During the workup for the latter,  myasthenia labs were noted to be positive for the acetylcholine receptor antibody. Subsequently, and although having no ocular complaints consistent with MG, the twin brother was also noted be seropositive for the antibody. The asymptomatic patient did not receive any treatment for his serum findings, while the twin brother received prism lenses and achieved correction of his diplopia with continued follow up. Neither patient developed any generalized symptoms.

Although the pathogenesis of myasthenia gravis is known to develop from an acquired autoimmune process, this case argues for the role of inheritable factors.  Similarly, this case prompts to question the direct role of the antibody in clinical manifestation and disease severity. Additionally, we are brought to wonder the prevalence of seropositive individuals who are asymptomatic and never manifest any clinical symptoms, as this case would suggest a new population of individuals to study further for improved pathological understanding.

Authors/Disclosures
Robert Craig Coppola, DO (University of Miami)
PRESENTER
Dr. Coppola has nothing to disclose.
Matthew Kay No disclosure on file
Mason Daniel Dyess, DO (Ochsner Medical Center- Kenner) Dr. Dyess has nothing to disclose.