Myasthenic Crisis in an Elderly Patient with Positive Antibodies against Acetylcholine and Anti-MuSK, Successfully Treated with Noninvasive Mechanical Ventilation

Case Reports in Critical Care
José A FernándezAntonio Lugo

Abstract

Myasthenia gravis is an autoimmune disease characterized by muscle weakness. Subjects with antibodies against acetylcholine usually have greater ocular symptoms, lower bulbar weakness, and fewer respiratory complications, compared to individuals with anti-MuSK antibodies. The presence of positivity to both types of antibodies in the same patient is uncommon, and the clinical behavior of these individuals is uncertain. A myasthenic crisis is characterized by respiratory and bulbar muscle weakness, causing acute respiratory failure which requires mechanical ventilatory support. We present the case of a 73-year-old man with a medical history of myasthenia gravis and positive antibody titers against acetylcholine and anti-MuSK, who sought for medical assessment because of respiratory tract infection symptoms, dysphagia, and generalized weakness. Initially, no respiratory distress was found. After 24 hours the patient showed respiratory deterioration and neurological impairment. Endotracheal intubation was rejected, so ventilatory support with noninvasive ventilation was started. The patient was supported by intense respiratory therapy, and infusion of immunoglobulin was initiated. The individual responded favorably, improving his g...Continue Reading

References

Dec 17, 2002·Critical Care Medicine·Panayiotis N VarelasDaniel F Hanley
Dec 8, 2004·Postgraduate Medical Journal·B R Thanvi, T C N Lo
Dec 27, 2005·Neurocritical Care·David Lacomis
Jan 16, 2008·Archives of Neurology·Janaka SeneviratneAlejandro A Rabinstein
Jul 21, 2009·Lancet·Stefano Nava, Nicholas Hill
May 5, 2010·Neurology·Ted M BurnsUNKNOWN MG Composite and MG-QOL15 Study Group
Feb 18, 2011·CMAJ : Canadian Medical Association Journal = Journal De L'Association Medicale Canadienne·Sean P KeenanUNKNOWN Canadian Critical Care Trials Group/Canadian Critical Care Society Noninvasive Ventilation Guidelines Group
Oct 22, 2013·Arquivos de neuro-psiquiatria·Daniel Agustin GodoyMario Di Napoli

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Autoimmune diseases occur as a result of an attack by the immune system on the body’s own tissues resulting in damage and dysfunction. There are different types of autoimmune diseases, in which there is a complex and unknown interaction between genetics and the environment. Discover the latest research on autoimmune diseases here.

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