2025 Volume 42 Issue 3 Pages 431-435
A 58–year–old man visited to our department due to ptosis and diplopia, and was diagnosed with ocular myasthenia gravis (oMG) based on an anti–acetylcholine receptor antibody level of 48 nmol/L. After treatment of pyridostigmine and prednisolone (PSL), his ocular symptoms improved. When he came to the ophthalmology department of our hospital, a steroid–induced intraocular pressure elevation was noted. Then, the PSL dose was decreased, and tacrolimus was started. Thereafter, he presented general symptom, and he was diagnosed with generalized MG (gMG). Even though the PSL and pyridostigmine dose was increased, his symptoms did not improve. Even after increasing of tacrolimus, he experienced head drop after working hard. To achieve further symptom improvement and PSL reduction, efgartigimod administration was introduced. After the administration of efgartigimod, his MG–ADL score and anti–acetylcholine receptor antibody level improved markedly during the 1st cycle. Also, the PSL dose was tapered, and no worsening of MG symptoms was observed. There are limited case reports of patients whose symptoms improved after early efgartigimod administration, within half a year after transition to gMG, and who were able to taper the oral PSL without an early fast–acting treatment strategy (EFT). Efgartigimod could be considered as a treatment option in before acute, refractory phase and EFT.
