Kishimoto N, Kondou H
Division of Pulmonary Medicine, Takamatsu Municipal Hospital, Kagawa, Japan.
Nihon Kokyuki Gakkai Zasshi. 1998 Oct;36(10):891-5.
A 61-year-old woman in excellent health and taking no medications presented with progressive dyspnea on exertion. She did not exhibit diplopia, dysphagia, dysarthria or muscle weakness. Her condition deteriorated, and respiratory distress developed. The patient was intubated and placed on mechanical ventilation. A computed tomogram of her chest revealed a moderately enlarged thymus gland unsuspected on a plain x-ray film. Myasthenia gravis was diagnosed on the basis of a high acetylcholine receptor antibody titer. Treatment started with prednisolone, anticholinesterase agent, and plasma exchange. The patient underwent a thymectomy 3 weeks after her diagnosis. Her symptoms were brought under control by anticholinesterase agent and prednisolone. This case illustrates the need to consider myasthenia gravis as well as other motor-neuron disorders when evaluating individuals presenting acute respiratory failure of unknown origin.
一名61岁身体健康且未服用任何药物的女性出现进行性劳力性呼吸困难。她没有出现复视、吞咽困难、构音障碍或肌无力。她的病情恶化，出现了呼吸窘迫。患者接受了气管插管并进行机械通气。胸部计算机断层扫描显示胸腺中度肿大，而在胸部X光平片上未被怀疑。根据高乙酰胆碱受体抗体滴度诊断为重症肌无力。治疗开始使用泼尼松龙、抗胆碱酯酶药物和血浆置换。患者在诊断后3周接受了胸腺切除术。她的症状通过抗胆碱酯酶药物和泼尼松龙得到了控制。这个病例表明，在评估不明原因急性呼吸衰竭的个体时，需要考虑重症肌无力以及其他运动神经元疾病。
