In our study, patient 1 had hyperthyroidism, and 2 had primary sclerosing cholangitis in addition to MG and UC, a triple association that has been reported only once before.18Patient 3 had MG, CD, and MS, and patient 4 had anti-MUSK MG, CD, and orbital pseudotumor, which are triple associations never reported previously. This evidence concerns the gene MUSK and orbital plasma cell granuloma.