Open AccessSuccessfully Treated Hepatitis B Positive Refractory Myasthenic Crisis with Rituximab
Author(s) -
Rupesh Kumar Singh,
Deepika Joshi,
Shivani Rath
Publication year - 2019
Publication title -
indian journal of critical care medicine/indian journal of critical care medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.317
H-Index - 30
eISSN - 1998-359X
pISSN - 0972-5229
DOI - 10.5005/jp-journals-10071-23320
Subject(s) - medicine , rituximab , refractory (planetary science) , myasthenia gravis , plasmapheresis , weakness , antibody , neuromuscular junction , refractory period , immunology , gastroenterology , surgery , neuroscience , physics , astrobiology , biology
Myasthenia gravis (MG) is an autoimmune disorder of neuromuscular transmission, which presents with fluctuating and variable weakness in ocular, bulbar, limb, and respiratory muscles resulting from an antibody-mediated, T-cell-dependent immunologic attack on the postsynaptic membrane of the neuromuscular junction. Although treatment of MG and myasthenic crisis is based on few specific principles, it is highly individualized. We report a successfully treated case of refractory myasthenic crisis who was on a ventilator for 7 months (210 days), perhaps the longest from India, and required multiple cycles of plasma exchange, intravenous immunoglobulin infusion, and one cycle of rituximab. It exemplifies the role of highly individualized therapy and interdisciplinary cooperation in management of refractory myasthenic crisis.