Öz
Myastenia gravis (MG), nikotinik asetilkolin reseptörlerine karşı antikorların gelişmesinden
kaynaklanan egzersizle kötüleşen değişken kas güçsüzlüğü ile karakterize kronik otoimmün bir
hastalıktır. Hastaların çoğunda nörolojik belirti ve semptomlar bulunsa da, solunum semptomları
hastalığın geç evrelerinde ortaya çıkar. Nadiren MG tanısı konulmamış hastalarda solunum yetmezliği
ilk semptom olabilir. Bu yazıda solunum yetmezliği ile başvuran ve entübe edilerek dahiliye yoğun
bakım ünitesine nakledilen yaşlı bir hastayı sunuyoruz. Entübasyondan iki gün sonra, uyanıkken ve
ekstübasyon kriterlerini karşıladığında extübe edilen hastanın bu sırada hayati belirtileri normaldi.
Ancak ertesi gün arteriyel kan gazında karbondioksit (CO2) yükseldi ve hasta uykulu hale geldi, bu
nedenle yeniden entübe edildi.
Bu durum yatışının beşinci ve 16. günlerinde tekrarladı ve roküronyum ile entübasyon sonrası uzamış
apne gözlendi. Sepsis ve pnömoni gibi başarısız ekstübasyonun diğer tüm nedenleri dışlandı.
Takiplerinde sağ gözde pitozis saptandı ve asetilkolin reseptör antikoru pozitifti. Takibinin 30. gününde
metilprednizolon 1mg/kg ve piridostigmin 240 mg/gün başlandı. Spontan solunumu yeterli olan hasta
ekstübe edilerek ileri tetkik ve tedavi için nöroloji servisine alındı.
Anahtar Kelimeler
Kaynakça
- Conti-Fine, B. M., Milani, M., & Kaminski, H. J. (2006). Myasthenia gravis: past, present, and future. The Journal of clinical investigation, 116(11), 2843–54.
- Fregonezi GA, Resqueti VR, Güell R, Pradas J, & Casan P (2005). Effects of 8-week, interval-based inspiratory muscle training and breathing retraining in patients with generalized myasthenia gravis. Chest, 128(3), 1524–30.
- Tsukada S, Shimizu S, & Fushimi K (2021). Rocuronium reversed with sugammadex for thymectomy in myasthenia gravis: A retrospective analysis of complications from Japan. European journal of anaesthesiology, 38(8), 850–5.
- Berrouschot J, Baumann I, Kalischewski P et al: Therapy of myasthenic crisis. Crit Care Med, 1997; 25: 1228–35
- Rabinstein A. A, & Mueller-Kronast, N. (2005). Risk of extubation failure in patients with myasthenic crisis. Neurocritical care, 3(3), 213–5.
- Tsukada S, Shimizu S, & Fushimi K. (2021). Rocuronium reversed with sugammadex for thymectomy in myasthenia gravis: A retrospective analysis of complications from Japan. European journal of anaesthesiology, 38(8), 850–5.
- Dontukurthy, S, Wisler, C, Raman, V, & Tobias JD (2020). Myasthenia gravis and sugammadex: A case report and review of the literature. Saudi journal of anaesthesia, 14(2), 244–8.
Öz
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.
Anahtar Kelimeler
Kaynakça
- Conti-Fine, B. M., Milani, M., & Kaminski, H. J. (2006). Myasthenia gravis: past, present, and future. The Journal of clinical investigation, 116(11), 2843–54.
- Fregonezi GA, Resqueti VR, Güell R, Pradas J, & Casan P (2005). Effects of 8-week, interval-based inspiratory muscle training and breathing retraining in patients with generalized myasthenia gravis. Chest, 128(3), 1524–30.
- Tsukada S, Shimizu S, & Fushimi K (2021). Rocuronium reversed with sugammadex for thymectomy in myasthenia gravis: A retrospective analysis of complications from Japan. European journal of anaesthesiology, 38(8), 850–5.
- Berrouschot J, Baumann I, Kalischewski P et al: Therapy of myasthenic crisis. Crit Care Med, 1997; 25: 1228–35
- Rabinstein A. A, & Mueller-Kronast, N. (2005). Risk of extubation failure in patients with myasthenic crisis. Neurocritical care, 3(3), 213–5.
- Tsukada S, Shimizu S, & Fushimi K. (2021). Rocuronium reversed with sugammadex for thymectomy in myasthenia gravis: A retrospective analysis of complications from Japan. European journal of anaesthesiology, 38(8), 850–5.
- Dontukurthy, S, Wisler, C, Raman, V, & Tobias JD (2020). Myasthenia gravis and sugammadex: A case report and review of the literature. Saudi journal of anaesthesia, 14(2), 244–8.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | İç Hastalıkları |
| Bölüm | OLD_Olgu Sunumu |
| Yazarlar | |
| Yayımlanma Tarihi | 18 Eylül 2023 |
| Gönderilme Tarihi | 19 Ocak 2023 |
| Yayımlandığı Sayı | Yıl 2023 |