{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T23:18:23Z","timestamp":1778887103958,"version":"3.51.4"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,1,24]],"date-time":"2025-01-24T00:00:00Z","timestamp":1737676800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>Myasthenia gravis (MG) is an autoimmune disorder within the spectrum of neuromuscular rare diseases, characterized by fluctuating muscle weakness. This report presents a case of a middle-aged woman with a chronic onset of asymmetric upper limb weakness accompanied by difficulty in finger extension, without ptosis or fluctuation for 4 years. The patient was finally diagnosed with MG by a significant decrement of Compound Muscle Action Potential in repetitive nerve stimuli, positive anti-acetylcholine receptor antibodies as well as the presence of a mass located in the anterior mediastinum. With subsequent immunotherapies for one month, the patient exhibited marked enhancement in muscle strength, followed by an uneventful thymectomy. After two months, the patient\u2019s symptoms were fully alleviated, as evidenced by the reduction in Quantitative MG Score from 9 to 4 points, Myasthenia Gravis Composite Score from 6 to 1 points, Myasthenia Gravis Activities of Daily Living Score from 4 to 1 points, and Myasthenia Gravis Quality of Life-15 score from 14 to 8 points respectively. This case highlights the importance of differentiating autoimmune disorders from hereditary neuromuscular diseases and initiating timely treatment.<\/jats:p>","DOI":"10.3389\/fimmu.2025.1498847","type":"journal-article","created":{"date-parts":[[2025,1,24]],"date-time":"2025-01-24T07:15:55Z","timestamp":1737702955000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Distal muscle weakness as the main onset symptom in thymoma-associated myasthenia gravis: a case report and literature review"],"prefix":"10.3389","volume":"16","author":[{"given":"Xuan","family":"Wu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiao-tian","family":"Xu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lin","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kai","family":"Qiao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chong-bo","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Su-shan","family":"Luo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,1,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(15)00145-3","article-title":"Myasthenia gravis: subgroup classification and therapeutic strategies","volume":"14","author":"Gilhus","year":"2015","journal-title":"Lancet Neurol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.2147\/EB.S389629","article-title":"Ocular myasthenia gravis: A current overview","volume":"15","author":"Behbehani","year":"2023","journal-title":"Eye Brain"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1007\/s10072-022-06489-8","article-title":"Distal upper limb involvement in myasthenia-myositis association","volume":"44","author":"Lauletta","year":"2023","journal-title":"Neurol Sci"},{"key":"B4","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1038\/s41582-023-00916-w","article-title":"Myasthenia gravis: the changing treatment landscape in the era of molecular therapies","volume":"20","author":"Iorio","year":"2024","journal-title":"Nat Rev Neurol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000011124","article-title":"International consensus guidance for management of myasthenia gravis: 2020 update","volume":"96","author":"Narayanaswami","year":"2021","journal-title":"Neurology"},{"key":"B6","doi-asserted-by":"publisher","first-page":"516","DOI":"10.1186\/s12967-021-03185-7","article-title":"Global prevalence of myasthenia gravis and the effectiveness of common drugs in its treatment: a systematic review and meta-analysis","volume":"19","author":"Salari","year":"2021","journal-title":"J Transl Med"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1007\/s40120-024-00619-4","article-title":"Epidemiology, patient characteristics, and treatment patterns of myasthenia gravis in Taiwan: A population-based study","volume":"13","author":"Tsai","year":"2024","journal-title":"Neurol Ther"},{"key":"B8","doi-asserted-by":"publisher","first-page":"e14568","DOI":"10.1111\/cns.14568","article-title":"Thymoma-associated autoimmune encephalitis with myasthenia gravis: Case series and literature review","volume":"30","author":"Su","year":"2024","journal-title":"CNS Neurosci Ther"},{"key":"B9","doi-asserted-by":"publisher","first-page":"e30015","DOI":"10.1016\/j.heliyon.2024.e30015","article-title":"Myasthenia gravis with tongue muscle atrophy: A case series","volume":"10","author":"Zhao","year":"2024","journal-title":"Heliyon"},{"key":"B10","article-title":"Neuromuscular disorders in critical illness","volume":"5","author":"Zochodne","year":"1996","journal-title":"Baillieres Clin Neurol"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.51.3.913","article-title":"Myasthenic hand","volume":"51","author":"Janssen","year":"1998","journal-title":"Neurology"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.52.3.632","article-title":"Distal myasthenia gravis","volume":"52","author":"Nations","year":"1999","journal-title":"Neurology"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-0404.2003.00136.x","article-title":"Distal myasthenia gravis frequency and clinical course in a large prospective series","volume":"108","author":"Werner","year":"2003","journal-title":"Acta Neurol Scand"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.3760\/cma.j.issn.0376-2491.2017.37.004","article-title":"Observation of clinical and electrophysiological features in patients with distal myasthenia gravis","volume":"97","author":"Jian","year":"2017","journal-title":"Zhonghua Yi Xue Za Zhi"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1002\/mus.24300","article-title":"Neuromuscular junction disorders mimicking myopathy","volume":"50","author":"Mongiovi","year":"2014","journal-title":"Muscle Nerve"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1002\/mus.25539","article-title":"Electrophysiological testing is correlated with myasthenia gravis severity","volume":"56","author":"Abraham","year":"2017","journal-title":"Muscle Nerve"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijscr.2019.10.069","article-title":"A case of thymoma in myasthenia gravis: Successful outcome after thymectomy","volume":"65","author":"Dahal","year":"2019","journal-title":"Int J Surg Case Rep"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1111\/ene.14820","article-title":"Clinical characteristics and outcomes of thymoma-associated myasthenia gravis","volume":"28","author":"Alvarez-Velasco","year":"2021","journal-title":"Eur J Neurol"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.3233\/JND-160148","article-title":"Myasthenia gravis: unusual presentations and diagnostic pitfalls","volume":"3","author":"Rodolico","year":"2016","journal-title":"J Neuromuscul Dis"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1007\/s13760-014-0364-1","article-title":"Myopathy, muscle atrophy and tongue lipid composition in MuSK myasthenia gravis","volume":"115","author":"Nikolic","year":"2015","journal-title":"Acta Neurol Belg"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1016\/0090-4295(89)90257-4","article-title":"Urinary incontinence after transurethral resection of prostate in myasthenia gravis patients","volume":"34","author":"Khan","year":"1989","journal-title":"Urology"},{"key":"B22","article-title":"Acute hemiparesis with hemichorea and crossed hemiparesis; unusual presentation for myasthenia gravis","volume":"34","author":"Ong","year":"1993","journal-title":"Singapore Med J"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.58.1.150-a","article-title":"Presentation of myasthenia gravis mimicking blepharospasm","volume":"58","author":"Roberts","year":"2002","journal-title":"Neurology"},{"key":"B24","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1111\/nyas.2018.1412.issue-1","article-title":"Developing treatment guidelines for myasthenia gravis","volume":"1412","author":"Sanders","year":"2018","journal-title":"Ann N Y Acad Sci"},{"key":"B25","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1186\/s40792-023-01655-2","article-title":"Autoimmune alopecia areata due to thymoma without myasthenia gravis: a case report","volume":"9","author":"Saito","year":"2023","journal-title":"Surg Case Rep"},{"key":"B26","doi-asserted-by":"publisher","first-page":"e36989","DOI":"10.1097\/MD.0000000000036989","article-title":"Diagnosis and evaluation of elderly-onset myasthenia gravis: A case report","volume":"103","author":"Tachikawa","year":"2024","journal-title":"Med (Baltimore)"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2025.1498847\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,24]],"date-time":"2025-01-24T07:15:59Z","timestamp":1737702959000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2025.1498847\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,24]]},"references-count":26,"alternative-id":["10.3389\/fimmu.2025.1498847"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2025.1498847","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,24]]},"article-number":"1498847"}}