Asymmetric pattern in generalized myasthenia gravis A case report

Thiago Pereira de Carvalho; Clara Louise Vianna; Felipe Freitas Andrade; Rafaela Abreu Alvarenga; Liz de Oliveira Moura Sales; Rosana Souza Rodrigues; Paulo Henrique Rosado-de-Castro

doi:10.1097/MD.0000000000013460

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Asymmetric pattern in generalized myasthenia gravis A case report

Journal article

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Asymmetric pattern in generalized myasthenia gravis A case report

Thiago Pereira de Carvalho, Clara Louise Vianna, Felipe Freitas Andrade, Rafaela Abreu Alvarenga, Liz de Oliveira Moura Sales, Rosana Souza Rodrigues and Paulo Henrique Rosado-de-Castro

Medicine (Baltimore), Vol.97(49), e13460

12/01/2018

DOI: 10.1097/MD.0000000000013460

PMID: 30544431

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Abstract

Rationale: Myasthenia gravis (MG) is an uncommon autoimmune disease mediated by antibodies that attack the postsynaptic acetylcholine receptors (AchRs) at the neuromuscular junction, causing fluctuating muscle weakness, aggravated with use, and relieved with rest. Patient concerns: A 32-year-old woman with a diagnosis of MG based on clinical findings, eletroneuromyography, and brain magnetic resonance imaging (MRI) was admitted to our hospital with dysphagia, dysphonia, diplopia, and intense weakness, associated with a 2-day viral gastroenteritis. Diagnoses: Physical examination revealed globally reduced deep tendon reflexes, and tetraparesis, with muscle strength grade 4 in the left limbs and grade 2 in the right limbs. Autoantibody dosing against AchR was elevated and computed tomography scan of the thorax revealed a thymic remnant. Interventions: Pyridostigmine and human immunoglobulin were infused. Outcomes: After 7 days of the reintroduction of pyridostigmine and human immunoglobulin infusion, the patient developed complete resolution of symptoms, being discharged from the hospital. Her symptoms are still well controlled 6 months later. The patient was evaluated by a thoracic surgeon and is awaiting elective thymectomy. Lessons: Although our patient presented all the diagnostic criteria of MG, the markedly asymmetric limb weakness presented in previous history and clinical examination of admission was an unusual and unexpected presentation, especially considering the pathophysiology of the disease. MRI of brain without abnormalities was fundamental to rule out another associated etiology. Our review of the literature revealed just 1 case report of MG with similar presentation. This clinical manifestation becomes valuable because it contributes to the list of unexpected presentation that should motivate its suspicion.

General & Internal Medicine

Life Sciences & Biomedicine

Medicine, General & Internal

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Details

Title: Subtitle: Asymmetric pattern in generalized myasthenia gravis A case report
Creators: Thiago Pereira de Carvalho - Faculdade de Medicina de Petrópolis
Clara Louise Vianna - Alcides Carneiro Hosp, Petropolis, RJ, Brazil
Felipe Freitas Andrade - Faculdade de Medicina de Petrópolis
Rafaela Abreu Alvarenga - Faculdade de Medicina de Petrópolis
Liz de Oliveira Moura Sales - Arthur Sa Earp Neto Fac, Petropolis Sch Med, Petropolis, RJ, Brazil
Rosana Souza Rodrigues - D’Or Institute for Research and Education
Paulo Henrique Rosado-de-Castro - Universidade Federal do Rio de Janeiro
Resource Type: Journal article
Publication Details: Medicine (Baltimore), Vol.97(49), e13460
DOI: 10.1097/MD.0000000000013460
PMID: 30544431
NLM abbreviation: Medicine (Baltimore)
ISSN: 0025-7974
eISSN: 1536-5964
Publisher: Lippincott Williams & Wilkins
Number of pages: 5
Language: English
Date published: 12/01/2018
Academic Unit: Radiology
Record Identifier: 9985143550802771

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