Lambert-Eaton myasthenic syndrome associated with idiopathic thrombocytopenic purpura and diffuse panbronchiolitis: Long-term remission after a course of intravenous immunoglobulin combined with low-dose prednisolone

We report a case of Lambert-Eaton myasthenic syndrome (LEMS) associated wit h idiopathic thrombocytopenic purpura (ITP) and diffuse panbronchiolitis (D PB). An extensive search for malignancy yielded negative results. Interesti ngly, ITP and DPB developed simultaneously when the patient suffered from m yasthenic symptoms. This is the first report in the Japanese or English lit erature of an association of LEMS, ITP, and DPB. The use of cholinesterase blocker alone did not improve the myasthenic symptoms, and the symptoms and signs relapsed with the tapering of prednisolone (PSL) dosage. However, af ter administration of immunoglobulin (IVIG) (0.4 g/kg/day x 5 days), tow-do se PSL (20 mg/day) alleviated the LEMS and ITP, and the diseases have remai ned in remission for 8 months without additional IVIG. We suspect that ther e is a synergistic relationship between IVIG and PSL.