Immunohistochemical detection of complement factors: a reliable method for the diagnosis of myasthenia gravis

A 57-year-old woman suffered from generalized muscular weakness without diplopia or dysphagia for about 2 years. An abnormal decremental response on low frequency nerve stimulation and improvement upon administration of edrophonium chloride suggested a diagnosis of myasthenia gravis. However,this diagnosis remained uncertain, since repeated tests for antiacetylcholine receptor antibodies were negative. In addition, the patient reported that she was never able to keep up with peers in prolonged physical activities since childhood. For this reason, a congenital myasthenic syndrome was suspected and an intercostal muscle biopsy performed for special end-plate studies. Immunohistochemistry of the muscle biopsy revealed membrane attack complex deposits at the end-plates. This finding definitely confirmed the diagnosis of autoimmune myasthenia gravis. In conclusion, immunohistochemistry for complement deposits at the end-plates is a simple and reliable method of confirming the diagnosis of myasthenia gravis in uncertain cases.