Occurrence of Biermer's Disease after 8 Years of Follow-Up of Myasthenia Gravis: about a Clinical Case

The auto immune myasthenia comorbidity and Biermer disease is less documented and rarely brought in the literature. We bring back the observation of a Senegalese patient hospitalized in our department of Neurology at Fann hospital (Dakar). It concerned a patient aged 58 years followed up for auto-immune myasthenia to antibodies anti-receptors of acetylcholine Ac RACH since 8 years and having a benefit of recurrent blood transfusion with a blood group A rhesus positive. He was received on neurologic consultation for a tiredness associated to an effort dyspnea and a gastro esophageal reflux accompanied by vomiting. The interrogatory found palpitations which necessitated a hospitalization two month before. Physical examination had objective a myasthenia syndrome, an anemic syndrome on the other hand, sub icteric mucosa’s were noted but no melanodermia no glossite. The rest of the physical examination was without particularity. The diagnoses of the Biermer illness was carried out in front of the anemic syndrome, the chronicity of the symptomatology without notion of fluctuation and the complementary exams having as objective a low rate of hemoglobin and a deficit in vitamin B12. The origin auto-immune of this anemia was confirmed by the immunologic test which had put in evidence a high rate of anti-bodies anti- intrinsic factor. The patient benefited from a blood transfusion then a treatment from cobalamin (for life) was also installed associated to a symptomatic management of the patient. The evolution after 6 weeks of the treatment was favorable with a complete regression of the dyspnea, vomiting and the attenuation of the effort tiredness. Myasthenia gravis and Biermer disease comorbidity has to be discussed in front of every myasthenia patient presenting clinical signs of effort dyspnea to a chronic anemia because early diagnoses of this association of Biermer illness and myasthenia gravis favors a better prognosis and not to progress to the combined degeneration of the spinal cord. The autoimmune substratum of the mechanism of this comorbidity remains to be elucidated but in all cases multidisciplinary management is necessary.