Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

A Case of Triple-Negative Myasthenia Gravis Lambert-Eaton Overlap Syndrome With Negative Agrin and LRP-4 Antibodies

Maturana, Miguel A. MD*; Bertorini, Tulio E. MD*; Mei, Lin MD; Pandhi, Abhi MD*; Mays, William H. MD*

Journal of Clinical Neuromuscular Disease: December 2019 - Volume 21 - Issue 2 - p 103–106
doi: 10.1097/CND.0000000000000189
Case Review

A case of triple-negative myasthenia gravis Lambert-Eaton overlap syndrome with negative Agrin and LRP-4 antibodies. Myasthenia gravis (MG) is an autoimmune disorder that shares similar features with Lambert-Eaton myasthenic syndrome. The combined clinical and electrophysiological findings of MG and Lambert-Eaton myasthenic syndrome have been reported, these cases represent the so-called “myasthenia gravis Lambert-Eaton overlap syndrome” (MLOS). A total of 55 MLOS cases have been identified, 13 cases were reported before the acetylcholine receptor (AChR) antibody (ab) testing era, 14 during the AChR-ab era, 26 during the voltage-gated calcium channel (VGCC)-ab era, and 2 cases have been reported during the muscle-specific kinase (MuSK)-ab era, of these; only 1 patient tested negative for all 3 antibodies. New immunological markers have been identified in the study of MG [Agrin and the low-density lipopro-tein receptor-related protein 4 (LRP-4)]. We present a patient with MLOS who tested negative for all 5 (AChR, MuSK, VGCC, Agrin, and LRP-4) serologic markers.

*Department of Neurology and Clinical Neurophysiology, Methodist University Hospital, University of Tennessee Health Science Center, Memphis, TN; and

Department of Neuroscience and Regenerative Medicine, Medical College of Georgia, Augusta University, Augusta, GA.

Reprints: Miguel A. Maturana, MD, 250 Arbor Commons Cir, Apt 307, Memphis, TN 38120 (e-mail:

The authors report no conflicts of interest.

We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved