A diagnosis of late-onset Myasthenia gravis unmasked by topical antibiotics

Myasthenia gravis in an old woman discovered during sedation for diagnostic digestive fibroscopy: Case report

Introduction and importance: Myasthenia gravis is an autoimmune disease characterized by the destruction of postsynaptic acetylcholine receptors in skeletal striated muscles. It is most common in young women. Myasthenia can be diagnosed by the detection of anti-acetylcholine receptor antibodies. Treatment includes anticholinesterase drugs, thymectomy, and restricting drugs that may aggravate myasthenia. The authors report a rare case of accidental revelation of myasthenia gravis in an elderly woman during sedation for diagnostic gastrointestinal fibroscopy. Case presentation: A 85-years-old female patient scheduled for diagnostic gastrointestinal fibroscopy presented signs of myasthenic crisis during the perioperative with severe respiratory failure. The diagnosis of myasthenia was confirmed by bioassay and electromyogram (EMG). Her chest CT scan showed a thymoma. The evolution was favorable as a result of early and appropriate management. Conclusion: Myasthenia can occur in perioperative settings outside the usual circumstances. The prognosis depends on early and adapted management.

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Myasthenia gravis is rare in women of advanced age.

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The myasthenic crisis can be inaugural of the disease whatever the age without distinction of sex.

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This case reports a form of discovery of the myasthenic crisis outside the usual circumstance.

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The early diagnosis and the implementation of a medical treatment allow extubating the patient quickly and successfully.

Myasthenia gravis associated with novel coronavirus 2019 infection: A report of three cases

Several neurological presentations have been reported following coronavirus 2019 (COVID-19) infection. This case report describes three myasthenia gravis (MG) patients presented following COVID-19 infection. We report three adult patients with myasthenic Gravis and COVID-19 infection. The patients are between 38 and 61 years old. Case 1 is a 61-year-old woman with progressive dysphagia, nasal speech, ocular ptosis, diplopia, and proximal muscle weakness for 10 days. She had a COVID-19 infection 6 weeks ago. Case 2 is a 57-year-old man with clinical symptoms of muscular fatigability, diplopia, ptosis, and dysphagia for a week and a positive COVID-19 infection 10 days ago. Case 3 is a 38-year-old woman with fatigability, ptosis, dysphagia, and a diagnosis of COVID-19 infection 4 weeks ago. All patients had a positive RT-PCR for COVID-19 infection by nasopharyngeal swab test and a high-level acetylcholine receptor antibody in the serum. All patients were treated with pyridostigmine and prednisolone with a favorable outcome. MG may appear following COVID-19 infection, and the role of molecular mimicry and latent MG activation should be considered the cause of the disease onset.