Open AccessDistal oesophageal spasm as a manifestation of myasthenia gravis
Author(s) -
Madhavi Karri,
Balakrishnan Ramasamy,
Santhosh Perumal
Publication year - 2021
Publication title -
romanian journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.111
H-Index - 4
eISSN - 2069-6094
pISSN - 1843-8148
DOI - 10.37897/rjn.2021.4.20
Subject(s) - myasthenia gravis , dysphagia , medicine , pyridostigmine , weakness , neuromuscular junction , muscle weakness , postsynaptic potential , proximal muscle weakness , anesthesia , esophagus , gastroenterology , muscle biopsy , surgery , biopsy , neuroscience , receptor , psychology
Myasthenia gravis is an autoimmune neuromuscular junction disorder affecting skeletal muscles. It is characterized by muscle fatigability with fluctuating weakness and diurnal variations. Here, we present an elderly female presented with subacute onset dysphagia predominantly to solids with weight loss for one month. Upper gastrointestinal endoscopy showed a crico-esophageal spasm. Manometric studies showed distal esophageal spasm with normal pressures. Clinically, she had proximal muscle weakness of all four limbs with bulbar weakness. Nerve conduction studies done were suggestive of postsynaptic neuromuscular junction disorder. Serum acetylcholinesterase receptor antibodies were elevated. We started her on pyridostigmine and low dose steroids, following which her symptoms improved. Here smooth muscle involvement was considered secondary to myasthenia gravis, which recovered after treatment. Treating physicians should even think of neurological causes in patients presenting with dysphagia predominant to solids.