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Elderly patient diagnosed with myasthenia gravis with recurrent failed weaning and prolonged apnea
Abstract
Myasthenia gravis (MG) is a chronic autoimmune neuromuscular disorder caused by the development
of antibodies to nicotinic acetylcholine receptors. The disease characterized by variable muscle
weakness worsening with exercise.
Although most patients have neurological signs and symptoms, respiratory symptoms occur in the late
stages of the disease. However, rarely, respiratory failure may be the first symptom in some
undiagnosed patients. We report the case of an elderly patient who was admitted with respiratory
failure and intubated and transferred to the internal medicine intensive care unit. Two days after
intubation, when she was awake and met the extubation criteria, endotracheal tube was successfully
removed. At this time, her vital signs were normal. However, next day, her arterial blood gas CO2 rose
and he became drowsy, requiring re-intubation. This situation repeated on the fifth and 16th days of
her hospitalization and prolonged apnea was observed after intubation with rocuronium. All other
causes of failed extubation, such as sepsis and pneumonia, were ruled out. During follow-up, ptosis
was detected in the right eye and acetylcholine receptor antibody was positive. On the 30th day of the
follow-up, methylprednisolone 1mg/kg and pyridostigmine 240 mg/day was initiated. The patient,
whose spontaneous respiration was sufficient, was extubated and taken to the neurology clinic for
further examination and treatment.
Keywords
References
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Details
Primary Language
English
Subjects
Internal Diseases
Journal Section
Case Report
Publication Date
September 18, 2023
Submission Date
January 19, 2023
Acceptance Date
April 22, 2023
Published in Issue
Year 2023 Volume: 62 Number: 3