A CASE OF MYASTHENIA GRAVIS WITH A FATAL OUTCOME THAT WAS DIFFICULT TO DIAGNOSE

Abstract

　We report the case of an 81-year-old man who visited the department of otorhinolaryngology of our hospital with the chief complaint of dysphagia, and was later diagnosed as having myasthenia gravis. The diagnosis in itself was challenging. At the beginning, the patient presented with only mild swallowing difficulty; however, the dysphagia progressed rapidly in severity, resulting in repeated episodes of aspiration pneumonitis. The patient was finally diagnosed as having myasthenia gravis.
　With the recent popularization of video endoscopic examination of swallowing, patients with a variety of diseases are often referred to us from other departments for this examination. While evaluating dysphagia, myasthenia gravis should be kept in mind as a possible underlying cause.
　Patients with advanced dysphagia should be examined in detail, bearing in mind the possibility of myasthenia gravis. For the diagnosis of myasthenia gravis, it is important to perform a series of careful examinations, including the serological test for anti-AChR antibody, the Tensilon test, and the repetitive nerve stimulation test.