open access

Vol 45, No 2 (2013 Apr-Jun)
Case reports
Submitted: 2013-07-05
Accepted: 2013-07-05
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Management of myasthenic crisis in a child

Beata Rybojad, Witold Lesiuk, Anna Fijałkowska-Nestorowicz, Paweł Rybojad, Marek Sawicki, Leszek Lesiuk
DOI: 10.5603/AIT.2013.0018
·
Anaesthesiol Intensive Ther 2013;45(2):82-84.

open access

Vol 45, No 2 (2013 Apr-Jun)
Case reports
Submitted: 2013-07-05
Accepted: 2013-07-05

Abstract

Myasthenia gravis is an autoimmune disorder of peripheral nervous system, leading to fluctuating muscle weakness. It is caused by circulating antibodies that block acetylcholine nicotinic postsynaptic receptors at the postsynaptic neuromuscular junction. Myasthenic crisis is a life-threatening complication, which is defined as weakness from acquired myasthenia gravis. In this paper we described a 15-year-old boy who was admitted to the Paediatric Intensive Care Unit due to myasthenic crisis. He had suffered not only from myasthenia gravis but also hypothyroidism, cerebral palsy and epilepsy. The patient required mechanical ventilation and was successfully treated with both plasmapheresis and intravenous immunoglobulins. He recovered from the crisis and then thymectomy was performed. Perioperative period and anaesthesia passed uncomplicated. Discharged home from the hospital after 2.5 month-treatment, for the last 4 years, he has only come on scheduled outpatient medical appointments. This case reveals that myasthenic crisis, albeit rare, may occur in male adolescents. In such cases multidisciplinary care followed by surgery becomes a procedure of choice. Concomitant medical problems, if well controlled, do not affect the results of outcome of the underlying disease.

Abstract

Myasthenia gravis is an autoimmune disorder of peripheral nervous system, leading to fluctuating muscle weakness. It is caused by circulating antibodies that block acetylcholine nicotinic postsynaptic receptors at the postsynaptic neuromuscular junction. Myasthenic crisis is a life-threatening complication, which is defined as weakness from acquired myasthenia gravis. In this paper we described a 15-year-old boy who was admitted to the Paediatric Intensive Care Unit due to myasthenic crisis. He had suffered not only from myasthenia gravis but also hypothyroidism, cerebral palsy and epilepsy. The patient required mechanical ventilation and was successfully treated with both plasmapheresis and intravenous immunoglobulins. He recovered from the crisis and then thymectomy was performed. Perioperative period and anaesthesia passed uncomplicated. Discharged home from the hospital after 2.5 month-treatment, for the last 4 years, he has only come on scheduled outpatient medical appointments. This case reveals that myasthenic crisis, albeit rare, may occur in male adolescents. In such cases multidisciplinary care followed by surgery becomes a procedure of choice. Concomitant medical problems, if well controlled, do not affect the results of outcome of the underlying disease.

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Keywords

myasthenia gravis, children; myasthenia gravis, myasthenic crisis; myasthenia gravis, general anaesthesia; myasthenic crisis, management; myasthenic crisis, plasmapheresis

About this article
Title

Management of myasthenic crisis in a child

Journal

Anaesthesiology Intensive Therapy

Issue

Vol 45, No 2 (2013 Apr-Jun)

Pages

82-84

DOI

10.5603/AIT.2013.0018

Bibliographic record

Anaesthesiol Intensive Ther 2013;45(2):82-84.

Keywords

myasthenia gravis
children
myasthenia gravis
myasthenic crisis
myasthenia gravis
general anaesthesia
myasthenic crisis
management
myasthenic crisis
plasmapheresis

Authors

Beata Rybojad
Witold Lesiuk
Anna Fijałkowska-Nestorowicz
Paweł Rybojad
Marek Sawicki
Leszek Lesiuk

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