Myasthenia Gravis Presenting as Isolated Respiratory Failure: A Case Report

Kim, Wonhee; Kim, Jung Hyun; Kim, Min Jung; Yun, Sang Pil; Kim, Kyung Keun; Jeong, Hoyoung

doi:10.3904/kjim.2010.25.1.101

Cited by 24 publications

(26 citation statements)

References 5 publications

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“…7 Isolated ocular muscle involvement is the most common presentation of MG, but weakness can also arise in bulbar or other muscles. There are few reports of acute respiratory failure as an initial presentation of MG. 10,11 The progression of respiratory failure in this case was much more acute than that of previous reports. Dyspnea developed 6 h after hospital admission, and mechanical ventilation was needed immediately after that.…”

Section: Discussioncontrasting

confidence: 50%

Myasthenia Gravis Presenting Initially as Acute Respiratory Failure

et al. 2014

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Section: Discussioncontrasting

confidence: 50%

Myasthenia Gravis Presenting Initially as Acute Respiratory Failure

et al. 2014

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“…Examples include unilateral abducens nerve palsy with diplopia and ataxia, isolated vocal cord paralysis with subsequent stridor, isolated dysphagia, and isolated respiratory failure. 4–7 Patients with MG have also exhibited esotropia with diplopia. 8 In a pediatric patient, MG presented as cyanosis and stridor, mimicking a foreign body aspiration.…”

Section: Introductionmentioning

confidence: 99%

Myasthenia Gravis Presenting as Persistent Unilateral Ptosis with Facial Droop

Golden

Reiff

Painter

et al. 2015

The Journal of Emergency Medicine

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Background Myasthenia gravis (MG) is an autoimmune neuromuscular disorder that is classically characterized by fluctuating weakness and fatigability of the ocular, bulbar, limb, or respiratory muscles. Over half of patients with MG will initially experience isolated ocular symptoms in one or both eyes. Most patients report that ocular symptoms are mild or undetectable upon awakening, and worsen throughout the day or with tasks such as driving. We describe an unusual case of MG presenting with an acute onset of persistent unilateral ptosis and ipsilateral facial droop without diurnal variation or other fluctuation in severity. Case Report A 58-year-old male presented to the Emergency Department with a three day history of persistent, unilateral ptosis with facial droop, concerning for stroke. However, head MRI found no evidence of stroke or any other central etiology. Routine laboratory testing was unremarkable. Neurology was consulted and they recommended sending acetylcholine receptor antibody tests. At the patient’s subsequent neurology clinic visit, these tests were found to be abnormal. Electromyography was also done at this visit, confirming the diagnosis of MG. The patient subsequently underwent thymectomy and immunosuppressive therapy, with great improvement in his symptoms. Why should an emergency physician be aware of this? MG may present as unilateral ptosis or facial drooping without the hallmark characteristic of fluctuating muscle weakness. Early diagnosis and subsequent treatment of MG improves long term prognosis and remission rates. Emergency physicians should consider myasthenia gravis in cases of unilateral ocular symptoms after ruling-out emergent central etiologies.

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“…The first case presented with multiple respiratory arrests, which is rare in the developed world 9. Unfortunately, despite having a clear history of progressive dysphagia, this was not identified until his second ICU admission.…”

Section: Discussionmentioning

confidence: 99%

“…MG can mimic some of the neuromuscular signs of Graves’ disease and when these disorders coexist, especially if MG signs are subtle, these signs can easily be missed or mistakenly be attributed to the Graves’ disease 9. This may result in a delay in diagnosis and treatment of MG. As such, a high degree of suspicion is needed when the clinical features of Graves’ disease are atypical.…”

Section: Introductionmentioning

confidence: 99%

Hickam's dictum: Myasthenia Gravis presenting concurrently with Graves' disease

Sehgal¹,

Rebello

Wolmarans

et al. 2017

BMJ Case Reports

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We present two patients with Graves' disease and concurrent myasthenia gravis. The impact of the dual diagnosis on the clinical course and the potential for a delayed diagnosis of myasthenia gravis is discussed. Patient 1, a 28-year-old man was diagnosed with Graves' disease following his second respiratory arrest. His history was strongly suggestive of a second pathology. Patient 2, a 66-year-old Cantonese woman with established Graves' disease presented with thionamide-related neutropaenia. Examination revealed bilateral ptosis and right lateral rectus palsy. Both patients had thyrotoxicosis secondary to Graves' disease with concurrent myasthenia gravis. Although neuromuscular weakness is common in Graves' disease, coexisting myasthenia gravis (MG) is rare and can cause profound morbidity. Ocular signs in both diseases may cause diagnostic confusion although ptosis suggests coexisting MG. In both cases, the thyrotoxicosis delayed the diagnosis of MG.

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Myasthenia Gravis Presenting as Isolated Respiratory Failure: A Case Report

Cited by 24 publications

References 5 publications

Myasthenia Gravis Presenting Initially as Acute Respiratory Failure

Myasthenia Gravis Presenting Initially as Acute Respiratory Failure

Myasthenia Gravis Presenting as Persistent Unilateral Ptosis with Facial Droop

Hickam's dictum: Myasthenia Gravis presenting concurrently with Graves' disease

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