{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T07:41:09Z","timestamp":1778226069335,"version":"3.51.4"},"reference-count":13,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,2,27]],"date-time":"2025-02-27T00:00:00Z","timestamp":1740614400000},"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:sec><jats:title>Introduction<\/jats:title><jats:p>Myasthenia gravis (MG) is an autoimmune disorder caused by autoantibodies that target the neuromuscular junction, leading to muscle weakness and fatigability. Diagnosis is based on clinical presentation, confirmation of the presence of AChR-Ab, characteristic electromyography findings, and clinical improvement after administration of acetylcholinesterase inhibitors.MG is often associated with thymoma and other autoimmune diseases, but it is rare following allo-HSCT.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case report<\/jats:title><jats:p>we reports two rare cases of MG after transplantation, including the first case of post-transplantation double-antibody-positive MG. Patient 1 was a 45-year-old woman diagnosed with B-cell acute lymphoblastic leukemia. She underwent haploidentical allo-HSCT from a female donor (5\/10 matching human leukocyte antigens [HLAs]) and developed graft-versus-host disease (GVHD) after transplantation. At 42 months after transplantation, the patient developed episodic generalized weakness, dysarthria, dysphagia, and axial weakness. The serum anti-acetylcholine receptor antibodies (AchR-Abs) level was &amp;gt; 20 nmol\/L (normal range: &amp;lt; 0.4 nmol\/L). She was diagnosed with MG type IIb according to the Myasthenia Gravis Foundation of America classification. At 44 months post-transplantation, the patient began to experience episodic cramps, Electromyography (EMG) revealed a small number of fibrillation potentials with the right thumb extensor and the right anterior tibial muscle in a relaxed state, as well as spastic discharge, considered indicative of cramp\u2013fasciculation syndrome (CFS). Improvement was seen following treatment with carbamazepine. Patient 2 was a 49-year-old man diagnosed with acute myeloid leukemia. He underwent haploidentical allo-HSCT from his son and did not develop GVHD. At 23 months post-transplant, the patient experienced recurrent diplopia, ptosis, axial weakness, and dyspnea. Neostigmine and repetitive nerve stimulation tests were positive, the level of anti-AChR IgG antibodies and MuSK receptor antibodies were positive, leading to a diagnosis of type IVb MG. The symptoms were mostly relieved after rituximab treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>This article reports two rare cases of MG after transplantation, including the first case of post-transplantation double-antibody-positive MG, and reviews the general clinical characteristics of MG cases after allo-HSCT reported in previous literature. These cases enhance our understanding of MG following transplantation and add to the data on post-transplantation MG.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fimmu.2025.1539666","type":"journal-article","created":{"date-parts":[[2025,2,27]],"date-time":"2025-02-27T07:11:47Z","timestamp":1740640307000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Successful treatment with refractory myasthenia gravis that developed after allogeneic hematopoietic stem cell transplantation: two case reports"],"prefix":"10.3389","volume":"16","author":[{"given":"Huili","family":"Zhang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yi","family":"Wen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yaotong","family":"Ou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xi","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu","family":"Peng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mingjun","family":"Lai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenjian","family":"Mo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Honghao","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,2,27]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199406233302507","article-title":"Myasthenia gravis","volume":"330","author":"Drachman","year":"1994","journal-title":"New Engl J Med"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(85)91742-8","article-title":"Bone-marrow grafting induces acetylcholine receptor antibody formation","volume":"325","author":"Smith","year":"1985","journal-title":"Lancet"},{"key":"B3","doi-asserted-by":"publisher","first-page":"2852","DOI":"10.1093\/brain\/awq245","article-title":"Neurological manifestations of chronic graft-versus-host disease after allogeneic haematopoietic stem cell transplantation: report from the consensus conference on clinical practice in chronic graft-versus-host disease","author":"Oliver","year":"2010","journal-title":"Brain A J Neurol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1038\/sj.bmt.1701575","article-title":"Myasthenia gravis and polymyositis as manifestations of chronic graft-versus-host-disease","volume":"23","author":"Tse","year":"1999","journal-title":"Bone Marrow Transplant"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-014-2225-0","article-title":"Neuromuscular complications after hematopoietic stem cell transplantation","volume":"22","author":"Koeppen","year":"2014","journal-title":"Support Care Cancer"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bmt.1700759","article-title":"Myasthenia gravis in association with allogeneic bone marrow transplantation: clinical observations, therapeutic implications and review of literature","volume":"19","author":"Mackey","year":"1997","journal-title":"Bone Marrow Transplant"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/j.hemonc.2017.04.001","article-title":"Myasthenia gravis after allogeneic bone marrow transplantation: A case report and literature review","volume":"12","author":"Tsutsumi","year":"2017","journal-title":"Hematol\/Oncol Stem Cell Ther"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.5152\/npa.2016.14816","article-title":"Clinical, electrophysiological, and serological evaluation of patients with cramp-fasciculation syndrome","volume":"54","author":"Poyraz","year":"2017","journal-title":"Noro Psikiyatri Arsivi"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.41.7.1021","article-title":"Cramp,Fasciculation syndrome: A treatable hyperexcitable peripheral nerve disorder","volume":"41","author":"Tahmoush","year":"1991","journal-title":"Neurology"},{"key":"B10","doi-asserted-by":"publisher","first-page":"365","DOI":"10.1038\/85520","article-title":"Auto-antibodies to the receptor tyrosine kinase musk in patients with myasthenia gravis without acetylcholine receptor antibodies","volume":"7","author":"Hoch","year":"2001","journal-title":"Nat Med"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1097\/WNP.0000000000000291","article-title":"Therapeutic implications of peripheral nerve hyperexcitability in muscle cramping: A retrospective review","volume":"33","author":"Hurst","year":"2016","journal-title":"J Clin Neurophysiol Off Publ Am Electroencephalographic Soc"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/j.jneuroim.2012.05.011","article-title":"Anti-musk- and anti-achr-positive myasthenia gravis induced by D-penicillamine","volume":"250","author":"Poulas","year":"2012","journal-title":"J Neuroimmunol"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/j.hemonc.2017.04.001","article-title":"Myasthenia gravis after allogeneic bone marrow transplantation: A case report and literature review","volume":"12","author":"Tsutsumi","year":"2019","journal-title":"Hematol Oncol Stem Cell Ther"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2025.1539666\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,27]],"date-time":"2025-02-27T07:11:50Z","timestamp":1740640310000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2025.1539666\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,27]]},"references-count":13,"alternative-id":["10.3389\/fimmu.2025.1539666"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2025.1539666","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,27]]},"article-number":"1539666"}}