Inoue Ken-Ichi, Tsugawa Jun, Fukae Jiro, Fukuhara Kosuke, Kawano Hiroyasu, Fujioka Shinsuke, Tsuboi Yoshio
Department of Neurology, Fukuoka University School of Medicine, Fukuoka, Japan.
Stroke center, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
Case Rep Neurol. 2020 Mar 17;12(1):114-120. doi: 10.1159/000506189. eCollection 2020 Jan-Apr.
A 31-year-old woman presented with a nasal voice, dysarthria, and upper limb weakness during her first pregnancy. Soon after delivery of her first baby, her symptoms disappeared. At the age of 34 years, during her second pregnancy, her nasal voice re-appeared. After delivery of the second baby, her nasal voice worsened, and bilateral eyelid ptosis and easy fatigability were also evident. She was referred to our hospital. Because of her myasthenic symptoms and anti-muscle-specific tyrosine kinase (MuSK) antibody (Ab)-positive status, she was diagnosed as having myasthenia gravis (MG). Her symptoms were worse than those in her first pregnancy. She was treated with oral steroid and double filtration plasmapheresis. After initiation of treatment, her myasthenic symptoms improved completely. In addition, her baby developed transient neonatal MG (TNMG) on the fourth day after birth and then gradually recovered over 30 days. It should be noted that symptoms of patients with anti-MuSK Ab-positive MG (MuSK-MG) can deteriorate during pregnancy, and the babies delivered of patients with MuSK-MG have a high probability of developing TNMG.
一名31岁女性在首次怀孕时出现鼻音、构音障碍和上肢无力。在她产下第一个婴儿后不久，症状消失。34岁时，她第二次怀孕，鼻音再次出现。在产下第二个婴儿后，她的鼻音加重，双侧眼睑下垂和易疲劳也很明显。她被转诊至我院。由于她有重症肌无力症状且抗肌肉特异性酪氨酸激酶（MuSK）抗体（Ab）呈阳性，她被诊断为重症肌无力（MG）。她的症状比首次怀孕时更严重。她接受了口服类固醇和双重过滤血浆置换治疗。治疗开始后，她的重症肌无力症状完全改善。此外，她的婴儿在出生后第四天出现了短暂性新生儿重症肌无力（TNMG），然后在30天内逐渐恢复。需要注意的是，抗MuSK Ab阳性重症肌无力（MuSK-MG）患者的症状在怀孕期间可能会恶化，MuSK-MG患者所生的婴儿发生TNMG的可能性很高。
