Anti-musk Myasthenic Crisis in the Puerperium: The Management Dilemma
Peter Appiah–Thompson *
Ear, Nose and Throat Unit, Cape Coast Teaching Hospital, Cape Coast, Ghana.
Yaw Asante Awuku
Department of Internal Medicine, University of Cape Coast, Cape Coast, Ghana.
Paul Masiowski
Department of Neurology, Royal University Hospital, Saskatoon, Canada.
Benedicta L. Appiah–Thompson
Eye Unit, Cape Coast Teaching Hospital, Cape Coast, Ghana.
Olukemi Olawaiye Dampson
New Crystal Hospital, Takoradi, Ghana.
*Author to whom correspondence should be addressed.
Abstract
Myasthenia gravis (MG) is a chronic neuromuscular junction (NMJ) dysfunction with a wide spectrum of neurological manifestations. MG is as a result of autoantibodies directed against NMJ at the postsynaptic level involving nicotinic or other postsynaptic antigens. The newly identified subtype of MG with antibodies against the muscle-specific receptor tyrosine kinase (Anti-MuSK) shows an unpredictable response to current MG treatment. The initial presentation of this disease entity often poses a diagnostic challenge and a treatment dilemma to the clinician. We present a case of life threatening Anti-MuSK-positive myasthenic crisis occurring during puerperium which required a temporary surgical airway and percutaneous endoscopic gastrostomy tube for feeding. She had dysphonia for 7 years but was not diagnosed. The complications and management dilemma of this case report are highlighted.
Keywords: Myasthenia gravis, myasthenic crisis, anti-MuSK, puerperium.