Myasthenia Gravis in a Chronic Spinal Cord Injury Patient: Case Report
DOI:
https://doi.org/10.25759/spmfr.426Keywords:
Botulinum Toxins, Type A/therapeutic use, Muscle Spasticity, Myasthenia Gravis, Spinal Cord InjuriesAbstract
Myasthenia gravis (MG) is an acquired autoimmune disorder characterized by fluctuating weakness and fatigability of skeletal muscle that is worse by the end of the day. We report a very rare case of a patient with a previous spinal cord injury (SCI) that was diagnosed with MG.
A 50-year-old man with AIS C quadriplegia, neurologic level C5, a central cord syndrome of traumatic etiology with an intrathecal baclofen pump and the need of regular botulinum toxin application in the upper limbs due to severe spasticity. In August 2018 he started complaining of fluctuating diplopia, headache, dysphagia, hypophonia and muscular weakness. Due to MG suspicion, he was admitted in October 2018 in a Neurology ward.
The complementary exams detected antibodies to the acetylcholine receptor and a decreasing response in repetitive nerve stimulation confirmed the diagnostic. He started treatment with corticosteroids and immunoglobulin with clinical improvement.
Since botulinum toxin worsens MG symptoms, it was not further applied, limiting spasticity treatment and deteriorating his functionality.
This case reports the coexistence of two unusual simultaneous entities: SCI and MG. The patient presented an incomplete SCI and severe spasticity which difficulted management of both pathologies, making this case uniquely challenging.
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