CASE REPORT

Myasthenic crisis in pregnancy: a case report

I Nyoman Hariyasa Sanjaya , Anton Supono, I Made Oka Adnyana, Ryan Saktika Mulyana, Evert Solomon Pangkahila, I Made Ariyana

I Nyoman Hariyasa Sanjaya
Obstetrics and Gynecology Department, Faculty of Medicine, Universitas Udayana, Sanglah Hospital, Bali-Indonesia. Email: [email protected]

Anton Supono
Resident of Obstetrics and Gynecology Department, Faculty of Medicine, Universitas Udayana, Sanglah Hospital, Denpasar, Bali-Indonesia

I Made Oka Adnyana
Neurology Department, Faculty of Medicine, Universitas Udayana, Sanglah Hospital, Denpasar, Bali-Indonesia

Ryan Saktika Mulyana
Obstetrics and Gynecology Department, Faculty of Medicine, Universitas Udayana, Sanglah Hospital, Denpasar, Bali-Indonesia

Evert Solomon Pangkahila
Obstetrics and Gynecology Department, Faculty of Medicine, Universitas Udayana, Sanglah Hospital, Denpasar, Bali-Indonesia

I Made Ariyana
Obstetrics and Gynecology Department, Faculty of Medicine, Universitas Udayana, Mangusada Hospital, Badung Regency, Bali-Indonesia
Online First: November 17, 2020 | Cite this Article
Sanjaya, I., Supono, A., Adnyana, I., Mulyana, R., Pangkahila, E., Ariyana, I. 2020. Myasthenic crisis in pregnancy: a case report. Bali Medical Journal 9(3): 632-637. DOI:10.15562/bmj.v9i3.2060


Introduction: This case report aims to describe the diagnostic strategy and optimal management of pregnancy with Myasthenia Gravis and Myasthenic Crisis.

Case Description: A 27-years-old pregnant female with Myasthenia Gravis complicated by Myasthenic Crisis was hospitalized six times during her pregnancy. Two initial hospitalizations due to acute exacerbation treated with plasmapheresis, and two other hospitalizations complicated with myasthenic crisis treated with massive Therapeutic Plasma Exchange in the Intensive Care Unit. Managing myasthenia gravis in pregnancy, from early pregnancy until delivery, is challenging. Furthermore, the myasthenic crisis in pregnancy is a rare case that requires airway and ventilation support and treatment with plasmapheresis.

Conclusion: Myasthenic crisis in pregnancy is a rare condition. Therefore, a guideline about the prenatal, antenatal, delivery plan, exacerbation, and myasthenic crisis management in pregnancy and pregnancy planning women are urgently needed.

References

Leveno KJ, Spong CY, Dashe JS, Casey BM, Hoffman BL, Cunningham FG, et al. Williams Obstetrics, 25th Edition. McGraw-Hill Education; 2018.

Ciafaloni E. Myasthenia Gravis and Congenital Myasthenic Syndromes. Contin Lifelong Learn Neurol. 2019;25(6):1767–84.

Inoue KI, Tsugawa J, Fukae J, Fukuhara K, Kawano H, Fujioka S, et al. Myasthenia Gravis with Anti-Muscle-Specific Tyrosine Kinase Antibody during Pregnancy and Risk of Neonatal Myasthenia Gravis: A Case Report and Review of the Literature. Case Rep Neurol. 2020;12(1):114–20.

Nguyen-Cao TM, Gelinas D, Griffin R, Mondou E. Myasthenia gravis: Historical achievements and the "golden age" of clinical trials. J Neurol Sci. 2019;406:116428. Available from: http://www.sciencedirect.com/science/article/pii/S0022510X19303600

Jaretzki A, Barohn RJ, Ernstoff RM, Kaminski HJ, Keesey JC, et al. Myasthenia gravis. Neurology. 2000;55(1):16–23. Available from: https://n.neurology.org/content/55/1/16

Wendell LC, Levine JM. Myasthenic Crisis. The Neurohospitalist. 2011;1(1):16–22.

Pradhan S, Pardasani V, Ramteke K. Azithromycin-induced myasthenic crisis: Reversibility with calcium gluconate. Neurol India. 2009;57(3):352.

Cadisch R, Streit E, Hartmann K. [Exacerbation of pseudoparalytic myasthenia gravis following Azithromycin (Zithromax)]. Schweiz Med Wochenschr. 1996;126(8):308–10.

Lefevre P, Report C. Myasthenia Gravis Unmasked by Azithromycin : A Case Report. 2013;17.

Bansal R, Goyal M, Modi M. Management of myasthenia gravis during pregnancy. Indian J Pharmacol. 2018;50(6):302.

Hurst RL, Gooch CL. Muscle-Specific Receptor Tyrosine Kinase (MuSK) Myasthenia Gravis. Curr Neurol Neurosci Rep. 2016;16(7):61.


No Supplementary Material available for this article.
Article Views      : 0
PDF Downloads : 0