Successfully Treated Hepatitis B Positive Refractory Myasthenic Crisis with Rituximab

Singh, Rupesh Kumar; Joshi, Deepika; Rath, Shivani

doi:10.5005/jp-journals-10071-23320

Cited by 4 publications

(3 citation statements)

References 8 publications

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“…Refractory MG which poses a challenge in its treatment has also been reported in the Indian literature. [ 23 ] Acquired neuromuscular disorders in critically ill patients comprising of critical illness myopathy and critical illness polyneuropathy or sometimes named CRIMYNE has to be kept in mind while seeing refractory MG patients. [ 24 ]…”

Section: Discussionmentioning

confidence: 99%

Clinical spectrum of myasthenia gravis: An institute experience over 8 years from North East India

Synmon

Rawat

Kynta

et al. 2022

J Family Med Prim Care

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A BSTRACT Background: Myasthenia gravis (MG) is a neuromuscular junction disorder usually associated with a thymic lesion. Aims and Objective: To study the clinical, serological, and thymic pathology in patient of MG from this corner of the country. Material and Method: A retrospective study involving all myasthenia patients presenting to neurology and cardio-thoracic department from the year 2013 to 2020. The clinical findings, Osserman grade of severity, antibodies profile, computed scanning thorax findings and histopathology of the thymic lesion were noted and collected as data. Results: Thirty patients of MG were included with mean age of onset being 39.10 ± 15.77 years which included 22 females and eight males. Four patients had only ocular findings while 26 patients had generalized myasthenia with three patients of respiratory failure. Ach receptor antibodies were positive in 27 patients and negative in two patients. Anti-MUSK was positive in one out of five patients. Abnormal findings in CT thorax seen in 20 patients which included enlarged thymic gland in 11 patients, thymic hyperplasia in two patients, thymoma in four patients, and anterior mediastinal mass in three patients. Thymectomy was done in eighteen patients with thymoma as the most common histopathological findings seen in eight patients, follicular hyperplasia in five patients; other was thymic hyperplasia, thymic cyst, normal thymus gland, and features of sarcoidosis in one patient. Conclusion: MG is a treatable autoimmune disorder with a variety of clinical, radiological, and histopathological findings.

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Section: Discussionmentioning

confidence: 99%

Clinical spectrum of myasthenia gravis: An institute experience over 8 years from North East India

Synmon

Rawat

Kynta

et al. 2022

J Family Med Prim Care

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“…76 Last, anti-CD 20 antibodies such as rituximab have been used in the treatment of long-lasting MC after failing initial treatment of IVIG or plasmapheresis, with mixed results. 24,25,77,78 Limited case descriptions suggest that its usage could lead to steady improvement and hasten the weaning from ventilator. 77,78 However, whether the observed efficacy can be attributed to the use of rituximab in this clinical situation is unclear.…”

Section: Potential Newer Therapies For MCmentioning

confidence: 99%

“…24,25,77,78 Limited case descriptions suggest that its usage could lead to steady improvement and hasten the weaning from ventilator. 77,78 However, whether the observed efficacy can be attributed to the use of rituximab in this clinical situation is unclear.…”

Section: Potential Newer Therapies For MCmentioning

confidence: 99%

Myasthenic crisis

Claytor

Cho

2023

Muscle and Nerve

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Myasthenic crisis (MC) is a life‐threatening manifestation of myasthenia gravis (MG) defined by respiratory insufficiency that requires the use of invasive or non‐invasive ventilation. This is often the result of respiratory muscle weakness but can also be due to bulbar weakness with upper airway collapse. MC occurs in approximately 15%–20% of patients with MG usually within the first 2 to 3 y of the disease course. Many crises have a specific trigger with respiratory infections being most common; however, no specific trigger is found in 30%–40% of patients. MG patients with a history of MC, severe disease, oropharyngeal weakness, muscle‐specific kinase (MuSK) antibodies and thymoma appear to be at higher risk. Most episodes of MC do not occur suddenly, providing a window of opportunity for prevention. Immediate treatment is directed toward airway management and removing any identified triggers. Plasmapheresis is preferred over intravenous immune globulin as the treatments of choice for MC. The majority of patients are able to be weaned from mechanical ventilation within 1 mo and the outcomes of MC are generally favorable. The mortality rate in United States cohorts is less than 5% and mortality in MC seems to be driven by age and other medical co‐morbidities. MC does not appear to affect long‐term prognosis as many patients are able to eventually achieve good MG control.

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Immune-globulin/rituximab/tenofovir

2020

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Successfully Treated Hepatitis B Positive Refractory Myasthenic Crisis with Rituximab

Cited by 4 publications

References 8 publications

Clinical spectrum of myasthenia gravis: An institute experience over 8 years from North East India

Clinical spectrum of myasthenia gravis: An institute experience over 8 years from North East India

Myasthenic crisis

Immune-globulin/rituximab/tenofovir

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