Chest
Selected ReportsMyasthenia Gravis Presenting as Isolated Respiratory Failure
Section snippets
CASE REPORT
A 64-year-old water pipe installer was diagnosed as having obesity-hypoventilation syndrome associated with recurrent cor pulmonale. Three months earlier, he had presented to another hospital with peripheral edema and weight gain. Values of a room air blood gas analysis were as follow: Po2, 61 mm Hg; Pco2, 51 mm Hg; pH, 7.37; (Table 1) and the chest x-ray film showed a reduction in lung volumes interpreted as poor inspiratory effort. No other abnormalities were noted. Spirometry showed FEV1 of
DISCUSSION
Myasthenia gravis can frequently be complicated by respiratory failure.15 However, myasthenic involvement limited solely to the muscles of ventilation has not been reported in well-characterized patients. In retrospective series of 22 myasthenics requiring mechanical ventilation reported by Gracey et al2, only four presented in this manner. None was described as having isolated respiratory failure. The conclusions of two earlier series by Ferguson et al3 (31 patients) and Ashworth and Hunter4
CONCLUSIONS
This case of myasthenia gravis was unusual in three respects: the patient presented with what appeared to be primary respiratory failure of unknown etiology; associated symptoms of myasthenia were suggested by history but could not be verified by objective means. Diagnosis was difficult despite a correct clinical impression in that several edrophonium trials as well as other standard tests for myasthenia gravis were negative. Treatment following diagnosis with accepted firstline agents,
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