Abstract
A 27-year-old man presented with acute nonlymphocytic leukemia (French–American–British Classification M2) in December 1988 and was induced into complete remission with daunorubicin and arabinosyl cytosine. In April 1989, he underwent successful bone marrow transplantation (BMT) from his human leukocyte antigen identical sister. One month after BMT, the patient developed a grade I cutaneous acute graft versus host disease (GVHD). By the fourth month, a moderate extensive chronic GVHD with persistent palmar erythema, xerostomia, and oral mucosae lichen was evident. He was treated continuously with cyclosporine A (CSA) and low dose 6-methylprednisolone, but after 46 months he started complaining of diplopia and arm muscular weakness. Electromyographic examination showed a 70% decrease of muscle action potential on repetitive stimulation at 3 Hz. Circulating antibodies against the acetylcholine receptor (ARAb) at a titer of 26 nmol/L were found. These data led to a diagnosis of MG developed in …
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