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Mira-Bhayandar: Doctors saved a teen with myasthenia crisis, a rare life threatening condition which is a long-lasting neuromuscular disorder. The disorder had caused breathing difficulty, double vision, inability to swallow food, and weight loss of 30 kgs over 2 years to the 17-year-old.
Gayatri Suta, a resident of Mira-Bhayander faced physical problem three years ago which began after the left eyelid stye after which she developed double vision as the first symptom. However, it recovered after some time.
Two years ago, after the demise of her father, her family shifted to Bikaner where she started having difficulty swallowing both liquids and solids which resulted in inadequate oral intake followed by weight loss of 30 kg in two years and inability to attend college for further studies. After consulting various specialists like ENT, gastroenterologists, and physicians, she even referred to a psychiatrist as she could not get a definitive diagnosis.
Two months ago, the family shifted back to Mira-Bhayander, where she decided to stop psychiatric medications and started searching for definitive treatment. On July 2, the patient had a fever and breathing difficulty, and she decided to consult Dr Aklesh Tandekar, head of consultant critical care at Wockhardt Hospitals, Mira Road and was admitted to ICU.
At the time of admission, she could not hold her breath to speak and was unable to swallow both liquids and solid food. After admission patient was detected to have shallow breathing for which she was started on non-invasive ventilation and oxygen support by Dr Sanggita Checker, consultant pulmonologist. CT scan of her chest showed retained secretions and dilatation of the food pipe.
Dr Pavan Pai, a consultant interventional neurologist at Wockhardt Hospitals in Mira Road said, “Patient had type 2 respiratory failure with retention of Carbon di-oxide making her drowsy. She could hardly make a sound with straining her neck muscles. She could communicate only by nodding her head or writing on paper and was being fed through a feeding tube.
However, the patient had Myasthenia crisis, a severe and life-threatening form of Myasthenia Gravis, a life-threatening neuromuscular disease in which antibodies are produced against frequently used muscles such as eye muscles, swallowing, and breathing muscles which are in action constantly.”
Myasthenia Gravis is a relatively uncommon disorder with incidence of 7 to 30 new cases per million. 10-20% of patient with Myasthenia Gravis experience at least one Myasthenia crisis. Risk factors for Myasthenia crisis include greater disease severity at diagnosis, presence of Thymoma which is a tumour seen in 15% of patients with Myasthenia Gravis and association with MUSK antibody like seen in this patient. Myasthenia Gravis can occur at any age but especially younger females and older males get affected.
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“The patient was started on IV Immunoglobulin therapy along with steroids and immunosuppressants. The patient gradually improved over three weeks and was discharged as she was able to eat and swallow both liquid and solid food and count to twenty in a single breath. After a month of treatment patient is now doing all the activities of daily living on her own without fatigue. She is able to have proper meals, hold conversations for more than five minutes and has gained 1.5 kg weight,” added Dr Pai.
