Rippling muscles and myasthenia gravis with rippling muscles
C. F. Ansevin and D. P. Agamanolis
St. Elizabeth's Medical Center, Youngstown, Ohio, USA.
OBJECTIVE: To describe a patient with rippling muscles and myasthenia
gravis. DESIGN: Clinical, laboratory, electrophysiologic, and muscle biopsy
data are reported. SETTING: Medical office and hospital. PATIENT: We
describe a patient with rippling muscles (as seen in rippling muscle
disease) and myasthenia gravis (MG) with thymoma. There was no family
history of rippling muscle disease in our patient. Diplopia and other
symptoms of MG were initially overshadowed by the striking rippling
phenomenon. The rippling resolved when the MG became florrid.
INTERVENTIONS: The patient was treated with pyridostigmine, prednisone, and
plasmaphereses before removal of a thymoma. MAIN OUTCOME AND RESULTS: His
MG improved with treatment and the rippling has not recurred 4 months after
thymectomy. CONCLUSIONS: Rippling muscle disease is rare and usually
inherited. Our patient with rippling muscles (but no family history of
rippling muscle disease) and MG suggests that rippling muscles may also be
triggered by an autoimmune phenomenon.