Sepsis Management in a Case of Myasthenic Crisis: A Case Report
Myasthenic crisis can affect the respiratory muscles in a life-limiting way that requires intubation and mechanical ventilation. This is a case report of a myasthenic crisis in a 61-year-old woman that became complicated following a lack of response to plasmapheresis, intravenous immunoglobulin (IV...
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| Format: | Article |
| Language: | English |
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Tehran University of Medical Sciences
2024-07-01
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| Series: | Archives of Anesthesia and Critical Care |
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| Online Access: | https://aacc.tums.ac.ir/index.php/aacc/article/view/986 |
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| author | Hossein Karballaei Mirzahosseini Ehsan Yousefi-Mazhin Rezvan Hassanpour Atabak Najafi Mahsa Tofighi-Mohammadi Hamidreza Sharifnia Amirmahdi Mojtahedzadeh Mojtaba Mojtahedzadeh |
| author_facet | Hossein Karballaei Mirzahosseini Ehsan Yousefi-Mazhin Rezvan Hassanpour Atabak Najafi Mahsa Tofighi-Mohammadi Hamidreza Sharifnia Amirmahdi Mojtahedzadeh Mojtaba Mojtahedzadeh |
| author_sort | Hossein Karballaei Mirzahosseini |
| collection | DOAJ |
| description |
Myasthenic crisis can affect the respiratory muscles in a life-limiting way that requires intubation and mechanical ventilation. This is a case report of a myasthenic crisis in a 61-year-old woman that became complicated following a lack of response to plasmapheresis, intravenous immunoglobulin (IVIG) therapy, and the development of septic shock. The co-occurrence of myasthenic crisis and sepsis is a challenging condition. Many antibiotics cause flare-ups of myasthenia gravis. Infection and sepsis can exacerbate myasthenia. We discuss the successful management of certain unique challenges. To treat sepsis, drugs that may cause deterioration of myasthenia gravis, such as amikacin, ciprofloxacin, colistin, vancomycin, amphotericin B, and voriconazole were prescribed, but eventually the sepsis was cured. After eradicating the infections and stabilizing the patient's hemodynamic, she received rituximab. After 3 weeks of treatment, she responded well to the rituximab, the respiratory failure recovered, and she was extubated and discharged from the ICU after 3 months of hospitalization. This report demonstrates that when the myasthenic patient is under mechanical ventilation, can use even cautionary drugs.
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| format | Article |
| id | doaj-art-bc14511372db4679a544a7d7e106e7e3 |
| institution | Kabale University |
| issn | 2423-5849 |
| language | English |
| publishDate | 2024-07-01 |
| publisher | Tehran University of Medical Sciences |
| record_format | Article |
| series | Archives of Anesthesia and Critical Care |
| spelling | doaj-art-bc14511372db4679a544a7d7e106e7e32025-02-09T08:53:32ZengTehran University of Medical SciencesArchives of Anesthesia and Critical Care2423-58492024-07-0111110.18502/aacc.v11i1.17499Sepsis Management in a Case of Myasthenic Crisis: A Case ReportHossein Karballaei Mirzahosseini0Ehsan Yousefi-Mazhin1Rezvan Hassanpour2Atabak Najafi3Mahsa Tofighi-Mohammadi4Hamidreza Sharifnia5Amirmahdi Mojtahedzadeh6Mojtaba Mojtahedzadeh7School of Pharmacy, Semnan University of Medical Sciences, Semnan, Iran.Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.Department of Anesthesiology and Critical Care Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.Department of Anesthesiology and Critical Care Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.Faculty of Medicine, Semmelweis University, Budapest, Hungary.Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. Myasthenic crisis can affect the respiratory muscles in a life-limiting way that requires intubation and mechanical ventilation. This is a case report of a myasthenic crisis in a 61-year-old woman that became complicated following a lack of response to plasmapheresis, intravenous immunoglobulin (IVIG) therapy, and the development of septic shock. The co-occurrence of myasthenic crisis and sepsis is a challenging condition. Many antibiotics cause flare-ups of myasthenia gravis. Infection and sepsis can exacerbate myasthenia. We discuss the successful management of certain unique challenges. To treat sepsis, drugs that may cause deterioration of myasthenia gravis, such as amikacin, ciprofloxacin, colistin, vancomycin, amphotericin B, and voriconazole were prescribed, but eventually the sepsis was cured. After eradicating the infections and stabilizing the patient's hemodynamic, she received rituximab. After 3 weeks of treatment, she responded well to the rituximab, the respiratory failure recovered, and she was extubated and discharged from the ICU after 3 months of hospitalization. This report demonstrates that when the myasthenic patient is under mechanical ventilation, can use even cautionary drugs. https://aacc.tums.ac.ir/index.php/aacc/article/view/986Myasthenic CrisisCautionary drugsSepsisMulti Drugs Resistance |
| spellingShingle | Hossein Karballaei Mirzahosseini Ehsan Yousefi-Mazhin Rezvan Hassanpour Atabak Najafi Mahsa Tofighi-Mohammadi Hamidreza Sharifnia Amirmahdi Mojtahedzadeh Mojtaba Mojtahedzadeh Sepsis Management in a Case of Myasthenic Crisis: A Case Report Archives of Anesthesia and Critical Care Myasthenic Crisis Cautionary drugs Sepsis Multi Drugs Resistance |
| title | Sepsis Management in a Case of Myasthenic Crisis: A Case Report |
| title_full | Sepsis Management in a Case of Myasthenic Crisis: A Case Report |
| title_fullStr | Sepsis Management in a Case of Myasthenic Crisis: A Case Report |
| title_full_unstemmed | Sepsis Management in a Case of Myasthenic Crisis: A Case Report |
| title_short | Sepsis Management in a Case of Myasthenic Crisis: A Case Report |
| title_sort | sepsis management in a case of myasthenic crisis a case report |
| topic | Myasthenic Crisis Cautionary drugs Sepsis Multi Drugs Resistance |
| url | https://aacc.tums.ac.ir/index.php/aacc/article/view/986 |
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