Myasthenia Gravis

A 57-year-male was admitted with difficulty in swallowing, breathing, and speaking for 2 months, which increased in the evenings. The onset was insidious and gradually progressive. Clinical examination revealed diplopia on horizontal gaze and wasting of muscles: intercostal, sternocleidomastoid, and flexors of the neck. There was no history of chest or cardiac disease and his oxygen saturation was low and respiratory rate was high. The patient was intubated and a nasogastric tube was inserted. He was started on high-dose methylprednisolone and tab pyridostigmine with other supportive measures. Serum acetylcholine receptor antibody was positive. MRI of the brain and CT of the chest were normal. After 7 days, tracheotomy and percutaneous endoscopic gastrostomy insertion were done. The patient gradually improved and was shifted to the ward. He was discharged in stable condition after 3 weeks of hospital admission with closed tracheostomy and in situ percutaneous endoscopic gastrostomy. He was on a tapering dose of steroid and pyridostigmine (60 mg 5 times daily) at first follow-up. Six months after admission his percutaneous endoscopic gastrostomy tube was removed.