Effectiveness of Therapeutic Plasma Exchange in a Patient of Myasthenia Gravis with an Atypical Presentation: A Case Report

¹Department of Transfusion Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India

²Assistant Professor, Department of Neurology, All India Institute of Medical Sciences, Patna, India

*Corresponding author: Dr. Satya Prakash Department of Transfusion Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India. Tel: +918872533400. E-mail: [email protected]

Citation: Prakash S, Kumar G. (2022). Effectiveness of therapeutic plasma exchange in a patient of myasthenia gravis with an atypical presentation: a case report. Cases. 1(1):1.

Received: April 23, 2022

Published: November 04, 2022

ABSTRACT

The grave muscle weakness in Myasthenia is attributed to circulating auto-antibodies against the nicotinic acetylcholine receptor, muscle-specific kinase, agrin, and others. Patients with myasthenia generally present with fatigue and drooping of eyelids, diplopia, and slurred speech. Sensory involvement is rare in Myasthenia Gravis. Most of these patients respond very well to steroids and other immunomodulatory drugs. Therapeutic plasma exchange (TPE) is used as first-line therapy to treat these patients presenting with the crisis. Here we report TPE in a case of myasthenia patients in crisis presenting with no eyeball movement in any gaze, mild dysphagia, and slurred speech. The patient underwent a total of 4 TPE procedures and in the end, she had improved diplopia with no ptosis and only a slightly nasal twang. This report emphasizes the role of TPE in atypical myasthenia with sensory involvement where the diagnostic dilemma exists.

Keywords: Plasma Exchange, Auto-antibody, Muscle weakness, Nicotinic acetylcholine receptor