Delayed Diagnosis of Atypical Presentation of Myasthenia Gravis
  • Moneeb Sefeldawla Mustafa
    Internal Medicine Department, St. Luke General Hospital, Kilkenny, Ireland
  • Megan Marshal
    Internal Medicine Department, St. Luke General Hospital, Kilkenny, Ireland
  • Emer Ahern
    Internal Medicine Department, St. Luke General Hospital, Kilkenny, Ireland
  • Paul Crowley
    Internal Medicine Department, St. Luke General Hospital, Kilkenny, Ireland

Abstract

Myasthenia gravis is an autoimmune disorder affecting the neuromuscular junction, resulting in muscle fatiguability and weakness.
The pathological characteristics of the disorder include ocular weakness resulting in diplopia and/or ptosis. More generally, the disease can result in fluctuant weakness of skeletal muscle, predominantly affecting ocular, bulbar and respiratory muscles. Autoimmunity in this instance is mediated by IgG anti-acetylcholine receptor antibodies that results in an impaired structure of postsynaptic neurotransmission. Approximately 15% of patients with myasthenia gravis present with bulbar symptoms, of which isolated bulbar symptoms are seen only on occasion. As with our patient, this presentation is most commonly seen in men with late-onset myasthenia gravis.
We present a case of an 83-year-old male who presented with a 1 year history of dysphagia for solids and fatigable dysarthria. Following a diagnosis of myasthenia gravis, he was initiated on corticosteroid treatment. He later descended into myasthenic crisis, requiring invasive ventilation measures due to a failure of both non-invasive ventilation and intravenous immunoglobulin G (IVIG) to achieve therapeutic goals.

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    Published: 2017-12-21
    Issue: Vol. 5 No. 2 (view)


    How to cite:
    1.
    Mustafa MS, Marshal M, Ahern E, Crowley P. Delayed Diagnosis of Atypical Presentation of Myasthenia Gravis. EJCRIM 2017;5 doi:10.12890/2017_000785.