Myasthenia Gravis Crisis Treatment Modalities

Myasthenia Gravis is a rare disorder, with an incidence rate of approximately 20 per 100,000 people in the US.It is characterized by muscle weakness that worsens with exertion and improves with rest [1].Often, the first presenting manifestation is involvement of extrinsic ocular muscles.Myasthenia can progress to other limb musculature as well as other bulbar muscles.The etiology of this disorder is unknown, but it is caused by circulating antibodies directed against acetylcholine receptors at the neuromuscular junction (NMJ).This disease process is highly treatable, especially with prompt recognition.A few of the main treatments involve immunoglobulins and plasma exchange.Here, we report a case of the complex nature of myasthenia crisis and the efficacy and length of appropriate treatments.A 79-year-old female with a past medical history of myasthenia gravis, presented with worsening shortness of breath that started the previous day.Chronically on pyridostigmine, she had an exacerbation of symptoms and entered into a crisis which involved extensive support such as intubation, ventilation, aggressive medical therapy, and use of intravenous immunoglobulins (IVIG) and plasma Exchange (PLEX).The patient was subsequently extubated and finished PLEX and IVIG courses.She continued to exhibit marked dysphagia, however, which required speech therapy and enteral feeding.Unfortunately, patient opted for discharge home with hospice care, as she no longer wanted to be treated despite her persistent dysphagia.This case highlights the importance of recognizing myasthenic crisis, the potency and efficacy of treatments, and associated complications.