Management of Myasthenic Crisis

Abstract

Reported: A case of myasthenic gravis (Osserman group IV) of late onset with thymoma in a 45 year old female. Thymecctomy and subsepuent cobalt radiation therapy had yielded no significant effect. Three years after thymectomy, she was admitted to our department of the Kansai Medical University hospital because of a myasthenic crisis of the brittle type with an anti-choline-esterase resistance.
After admission, tracheostomy was performed and an intermittent positive pressure respirator was applied. During course, however, a number of complications occurred, including cardiac shock, disturbed inflation of fhe left lung due to mediastinal pleural adhesion, severe infections (lung and urinary tract by pseudomonaus aeruginosa, klebsiella, and candida developing into candida sepsis in the prolonged cour se), drug allergies (sulpenicillin, ampicillin,, and amphotericine B), hepatomegaly with liver dysfunctions, and kidney involvement.
Therefore, the patient was treated with intensitive chemotherapy, adrenal corticosteroid, ACTH, transfusion to maintain electrolyte balance, and nasal feeding of a high caloric diet.
These treatments finally rescued the patient from the crisis, and eight months later, she was discharged. Discussed: The Management of a severe myasthenic crisis in due consideration of pathophysiological conditions.