Immunosuppressive treatment of rippling muscles in patients with myasthenia gravis

Rippling muscle disease is a rare autosomal dominant disorder that may occu r sporadically, In this report two patients presenting with rippling muscle s followed by myasthenia gravis are described. Our first patient developed rippling muscles about 1 month after infection with Yersinia enterocolitica . Two years later myasthenia gravis appeared, Our second patient had a 2-ye ar history of asthma prior to the onset of rippling muscles which preceded the myasthenic symptoms by 4-8 weeks. Acetylcholine receptor and anti-skele tal muscle antibody titers were positive in bath patients, in both patients the rippling phenomena worsened with pyridostigmine treatment but markedly improved after immunosuppression with azathioprine. (C) 1999 Elsevier Scie nce B.V, All rights reserved.