A 35-year-old caucasian female presented with acute onset bilateral ptosis
while driving, followed by weakness of the facial and upper limb muscles. A
diagnosis of myasthenia gravis (MG) was made on the basis of clinical exam
ination, and confirmed by electromyography, high titres of anti-acetylcholi
ne receptor antibodies and a positive response to pyridostigmine. She under
went thymectomy and her symptoms resolved. She presented again 16 years lat
er (age 51) with tiredness, jaundice and a biochemical hepatitis. Serologic
al and histopathological investigations were in keeping with autoimmune chr
onic hepatitis and there was a satisfactory response to oral prednisolone.
She was unable to tolerate the conventional high dose steroid induction due
to a relapse of her MG but subsequently entered remission with intermediat
e dose regime of prednisolone. Despite a recognised association between bot
h autoimmune hepatitis (AIH) and MG with other autoimmune diseases, a liter
ature search showed the combination of these two conditions to be extremely
rare with only one adequately documented previous report. (C) 1999 Elsevie
r Science Ireland Ltd. All rights reserved.