Successfully Treated Hepatitis B Positive Refractory Myasthenic Crisis with Rituximab

JOURNAL TITLE: Indian Journal of Critical Care Medicine

Author
1. Deepika Joshi
2. Shivani Rath
3. R Kumar Singh
ISSN
0972-5229
DOI
10.5005/jp-journals-10071-23320
Volume
24
Issue
1
Publishing Year
2020
Pages
1
Author Affiliations
1. com.mps.common.model.Contributor@2097baec ,
2. com.mps.common.model.Contributor@27e5e3fd ,
3. com.mps.common.model.Contributor@74eb052e
Article keywords
Myasthenia gravis, Myasthenic crises, Rituximab

Abstract

Myasthenia gravis (MG) is an autoimmune disorder of neuromuscular transmission, which presents with fluctuating and variable weakness in ocular, bulbar, limb, and respiratory muscles resulting from an antibody-mediated, T-cell-dependent immunologic attack on the postsynaptic membrane of the neuromuscular junction. Although treatment of MG and myasthenic crisis is based on few specific principles, it is highly individualized. We report a successfully treated case of refractory myasthenic crisis who was on a ventilator for 7 months (210 days), perhaps the longest from India, and required multiple cycles of plasma exchange, intravenous immunoglobulin infusion, and one cycle of rituximab. It exemplifies the role of highly individualized therapy and interdisciplinary cooperation in management of refractory myasthenic crisis.

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