Klair Jagpal Singh, Rochlani Yogita M, Meena Nikhil K
Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
BMJ Case Rep. 2014 Apr 17;2014:bcr2014204163. doi: 10.1136/bcr-2014-204163.
Myasthenia gravis (MG) is a neuromuscular disorder that typically affects the ocular, bulbar, neck, proximal limbs and respiratory muscles. Dysphagia can occasionally be the only presenting symptom leading to extensive but ultimately futile gastrointestinal workup. Delay in diagnosis and use of certain pharmacological agents in the interim can lead to a myasthenic crisis, which though diagnostic is life threatening. We document a case of dysphagia as the only symptom of myasthenia, diagnosed after a magnesium infusion precipitated myasthenic crisis. A 70-year-old Caucasian woman who had had progressive dysphagia for 2 years, for which multiple oesophageal dilations were performed. During a hosptalisation for further gastrointestinal workup, she went into myasthenic crisis (respiratory failure) after receiving magnesium replacement. She required ventilatory support and received five plasma exchange (PLEX) treatments after myasthenia was confirmed by the detection of high antiacetylcholine receptor antibody. Though her symptoms improved, she had a prolonged hospital stay (25 days) and required 18 days of mechanical ventilation. This underscores the morbidity associated with a delay in diagnosis of this condition. This case report suggests that neuromuscular causes should be considered early in elderly patients presenting with dysphagia. Timely diagnosis, initiation of management and avoidance of drugs that affect neuromuscular transmission may help reduce the morbidity and mortality associated with myasthenic crisis.
重症肌无力（MG）是一种神经肌肉疾病，通常会影响眼部、延髓、颈部、近端肢体和呼吸肌。吞咽困难偶尔可能是唯一的症状，导致进行广泛但最终徒劳的胃肠道检查。诊断延迟以及在此期间使用某些药物可能会引发重症肌无力危象，尽管这有助于诊断，但却危及生命。我们记录了一例以吞咽困难为重症肌无力唯一症状的病例，该病例在静脉输注镁引发重症肌无力危象后得以确诊。一名70岁的白人女性，进行性吞咽困难已有2年，为此接受了多次食管扩张治疗。在住院进行进一步胃肠道检查期间，她在接受镁补充治疗后出现了重症肌无力危象（呼吸衰竭）。在通过检测高抗乙酰胆碱受体抗体确诊重症肌无力后，她需要通气支持并接受了5次血浆置换（PLEX）治疗。尽管她的症状有所改善，但住院时间延长（25天），需要机械通气18天。这突出了这种疾病诊断延迟所带来的发病率。本病例报告表明，对于出现吞咽困难的老年患者，应尽早考虑神经肌肉病因。及时诊断、开始治疗并避免使用影响神经肌肉传递的药物，可能有助于降低与重症肌无力危象相关的发病率和死亡率。
