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Anti-MuSK myasthenia gravis presenting with Epstein-Barr virus-associated mononucleosis and immune-mediated diabetes mellitus


We report a young woman with the abrupt onset of infectious mononucleosis due to Epstein–Barr virus associated with a subsequent autoimmune form of diabetes mellitus and myasthenia gravis with anti–muscle-specific kinase (MuSK) antibodies. The simultaneous onset of these two autoimmune diseases preceded by a systemic viral illness supports a causal relationship between MuSK antibodies and myasthenia gravis and suggests the possibility of a viral trigger in some cases. Muscle Nerve, 2007