Rippling muscles and myasthenia gravis with rippling muscles

Objective: To describe a patient with rippling muscles and myasthenia gravis. Design: Clinical, laboratory, electrophysiologic, and muscle biopsy data are reported. Setting: Medical office and hospital. Patient: We describe a patient with rippling muscles (as seen in rippling muscle disease) and myasthenia gravis (MG) with thymoma. There was no family history of rippling muscle disease in our patient. Diplopia and other symptoms of MG were initially overshadowed by the striking rippling phenomenon. The rippling resolved when the MG became florrid. Interventions: The patient was treated with pyridostigmine, prednisone, and plasmaphereses before removal of a thymoma. Main Outcome and Results: His MG improved with treatment and the rippling has not recurred 4 months after thymectomy. Conclusions: Rippling muscle disease is rare and usually inherited. Our patient with rippling muscles (but no family history of rippling muscle disease) and MG suggests that rippling muscles may also be triggered by an autoimmune phenomenon.