A Severe Case of Myasthenia gravis during Pregnancy

Abstract

Myasthenia gravis is characterised by muscle weakness and fatigability, particularly of the facial and extremity muscles, deteriorating during the day. During pregnancy, myasthenia gravis is rare and the course of illness is unpredictable. The present case illustrates that first diagnosed during pregnancy, recurrent exacerbations can appear and lead to life-threatening situations.

Henoch-Schonlein purpura in pregnancy

“…There is an oestrogen‐dependent polyclonal stimulation of B cells, and total antibody production is increased during pregnancy. This may explain how antibody‐mediated diseases such as systemic lupus erythematosus, myasthenia gravis and autoimmune blistering diseases may be exacerbated in pregnancy, whereas many T‐cell‐mediated inflammatory diseases such as rheumatoid arthritis and multiple sclerosis may improve during pregnancy 9–12 . A similar mechanism may be responsible for the onset or exacerbation of HSP during pregnancy.…”

Neuromuscular disorders in pregnancy

“…Myasthenia gravis (MG) is an autoimmune disorder that occurs in women of childbearing age and is diagnosed in an estimated 1 in 20,000 pregnancies. 90 Pregnancy has a variable effect on disease relapse but does not worsen the long-term outcome of MG. 9 Among 322 pregnancies in 225 myasthenic women, disease relapse occurred in 41% of pregnancies and remission in 29%. 94 Postpartum exacerbations were often sudden and associated with respiratory failure.…”

“…26 One to 5 years after thymectomy, disease remission approaches 50%, and some studies suggest that thymectomy is most effective when performed within the first 2 years of disease onset. 90,99 For symptomatic treatment, anticholinesterase medications may be used in pregnancy (pregnancy category C). Pregnancy-related changes in intestinal absorption and renal clearance may alter the amount of anticholinesterase needed.…”

Myasthenia Gravis and Pregnancy

“…A simple upper respiratory tract infection can lead to a life-threatening respiratory crisis in need of mechanical ventilation [9]. Besides, common symptoms of the first trimester, such as nausea and vomiting, can lead to subtherapeutic levels of medication, sometimes requiring parenteral therapy.…”