M y a s t h e n i a gravis is an autoimmune disorder caused by the breakdown in T-cell and B-cell tolerance to acetylcholine receptors.i IgG autoantibodies to acetylcholine receptors have been isolated in 90% of patients with the disease. These autoantibodies lead to a decrease in the number of acetylcholine receptors, thus blocking neuromuscular transmission. 2 Clinically, myasthenia gravis is characterized by weakness and fatigability of skeletal muscle after exercise. This response is exacerbated by stressors such as infection and general fatigue.We present an unusual case of this disease in which the patient reported a swollen tongue, which was incorrectly diagnosed and treated as angioedema. Because oropharyngeal features are present in up to 56% of patients with myasthenia gravis at the time of presentation, it is essential that otolaryngologists be aware of this disease. 3
CASE REPORTA 56-year-old man came to the emergency department with subjective airway distress caused by a swollen tongue (Fig. 1). The patient had a 5-month history of recurrent tongue swelling, which had caused dyspnea, dysarthria, and dysphagia. Despite evaluation by a general practitioner and specialists (emergency medicine, allergy, and gastroenterology), treatment with steroids, and hospitalization, the symptoms persisted. The presumptive diagnosis was angioedema caused by treatment with enalapril (Vasotec), an angiotensin-converting enzyme inhibitor. This treatment was discontinued but without resolution of the patient's symptoms.