CASE
A 79 year old woman, a heterozygote for factor V
Leiden, had diffuse weakness. It started in the
summer of 2013. She ...
In the hospital, she had a CTA to rule out
recurrent emboli as the cause of her dyspnea.
Troponins were slightly elevated....
On December 4, she went to the POMH ER
because she could not swallow water. Physicians
ordered an antiAChR antibody and se...
The medical student on her
case called for a Neurology
consult on December 5th.
He said she had diffuse
weakness and was
s...
The NIF returned at
-10. She was
transferred to the ICU,
under the care of the
hospitalists. Her
ABGs, on 3 L, were
pH 7.2...
Pharmacy Help
AChR BINDING AB: 50.5
MuSK Antibody Titer: <10
_____________________________________
ACh RECEPTOR MODULATING Ab: 81
0-20% ...
Myasthenia gravis
Myasthenia gravis
Myasthenia gravis
Myasthenia gravis
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Myasthenia gravis

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Myasthenia gravis

  1. 1. CASE A 79 year old woman, a heterozygote for factor V Leiden, had diffuse weakness. It started in the summer of 2013. She was admitted in September for proximal weakness of her upper and lower extremities. She had difficulty holding her head up. She used ski poles to walk. She had fallen. She was dyspneic. She had had pulmonary emboli. She takes warfarin.
  2. 2. In the hospital, she had a CTA to rule out recurrent emboli as the cause of her dyspnea. Troponins were slightly elevated. A cardiology consultant found no cardiologic cause for her weakness. CK was normal. Anti-smooth muscle antibodies were neg. She had a Klebsiella UTI, and received antibiotics. She was discharged.
  3. 3. On December 4, she went to the POMH ER because she could not swallow water. Physicians ordered an antiAChR antibody and sent her to the MMC ER, where she was admitted that evening. Her magnesium was low at 1.4.
  4. 4. The medical student on her case called for a Neurology consult on December 5th. He said she had diffuse weakness and was somewhat dyspneic. They thought she had myasthenia gravis. He said an anti-AchR antibody test had been ordered, but results were pending.
  5. 5. The NIF returned at -10. She was transferred to the ICU, under the care of the hospitalists. Her ABGs, on 3 L, were pH 7.26, pCO2 56, pO2 136. She was put on a non-rebreather.
  6. 6. Pharmacy Help
  7. 7. AChR BINDING AB: 50.5 MuSK Antibody Titer: <10 _____________________________________ ACh RECEPTOR MODULATING Ab: 81 0-20% (reported as _% loss of AChR) STRIATIONAL (STRIATED MUSCLE) : Positive 1:15360 Reference range: <1:60 AChR BINDING AB: 39.6 Reference range: <=0.02
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