Personalized Treatment of Myasthenia Gravis: Clinical Case Report

Abstract

Myasthenia gravis (MG) is a rare autoimmune disorder based on the type II hypersensitivity immune response. Antibodies attack the nicotinic acetylcholine postsynaptic receptors, resulting in a decreased number of acetylcholine receptors (AChRs) at the neuromuscular junction (NMJ), resulting in the typical pattern of MG: fatigable general weakness after physical activities, fluctuating diplopia or ptosis, as well as any other skeletal muscle involvement. According to the statistics, 15–20% of MG patients experience exacerbation or crisis within the first 2 years after diagnosis. MG crises or exacerbations represent life-threatening and potentially lethal conditions, which should be evaluated and treated accordingly. Before deciding on the individualized treatment regimens, several factors, such as the severity and rapidity of symptom progression, the patient's medical history and the physician's clinical experience should be taken into consideration. A 64-year-old female diagnosed with myasthenia gravis presented with left-sided ptosis, diplopia, dysphagia, alongside difficulty breathing. The patient's medical history revealed arterial hypertension, type II diabetes, obesity and lacunar stroke. After a physical examination, the exacerbation was determined to be less severe and was assigned to MGFA Class II. Considered rapid treatments, such as 5-7 plasma exchange procedures were reduced to four procedures, and human immunoglobulin (IVIg) infusions were discontinued entirely. This action was taken as a result of the high cost of the plasma exchange and IVIg infusion treatments, which the patient could not afford and for which the insurance companies were unable to pay. We assumed the risk based on the personalized strategy, therefore we started therapy with Solumedrol (Methylprednisolone) 1000 mg intravenouslyover the course of three days. Additionally, we considered the urgent management of the high arterial blood pressure and blood glucose levels that showed a progressive positive effect on the patient's general health in addition to myasthenia gravis exacerbation symptoms within three days.