Dysphagia as presenting symptom of myasthenia gravis: a case series of successful outcome in multidisciplinary approach

https://doi.org/10.19106/JMedSci005203202010

Anton Haryono(1), Rery Budiarti(2), . Muyassaroh(3*)

(1) Otolaryngology Department of Medical Faculty, Universitas Diponegoro/Dr. Kariadi General Hospital, Semarang, Indonesia
(2) Otolaryngology Department of Medical Faculty, Universitas Diponegoro/Dr. Kariadi General Hospital, Semarang, Indonesia
(3) Otolaryngology Department of Medical Faculty, Universitas Diponegoro/Dr. Kariadi General Hospital, Semarang, Indonesia
(*) Corresponding Author

Abstract


Dysphagia can be caused by mechanic or neurologic disorders. Neurologic dysphagia is commonly related to cerebrovascular disease, parkinson disease, amyotropic lateral sclerosis, tardive dyskinesia, and myasthenia gravis (MG). About 15-40% dysphagia occurred in MG generalized type. Only 6% MG with dysphagia were reported as a single symptom. The case reports aimed to demonstrate the role of otolaryngologist in multidisciplinary approach of the MG management. Two cases of MG were reported. First case was a 33 years old woman with moderate MG generalized type with ocular, dysphagia, and disarthria symptoms and second case was a 46 years old man with acute severe MG with crisis. Management therapy was applied according to onset and severity of MG. Acetylcholinesterase (AChE) and corticosteroid were administered for the first case, whereas therapeutic plasma exchange (TPE) for second case. In conclusion, disfagia in MG can be accompanied with other symptom, therefore its management should be based on the severity in order to give a positive result.


Keywords


miasthenia gravis; dysphagia;

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References

  1. Kuhn MA, Belafsky PC. Functional assessment of swallowing In: Johnson JT, Rosen CA, editors. Bailey’s head and neck surgery-otolaryngology, 5th edition. Philadelphia: Lippincott Williams & Wilkins, 2014:825-36.
  2. Ramalho S, Pereira S, Oliveira P, Morais H, Lima N, Conde A. Dysphagia as a presenting symptom of myasthenia gravis: case report. Int J Otolaryngol Head Neck Surg 2014;3:23-5. https://doi.org/10.4236/ijohns.2014.31005
  3. Ho S & Liu A. A co-occurence of serologically proven myasthenia gravis and pharyngeal-cervical-brachial variant of Guillain-Barre syndrome. Case Report Neurol Med 2019; 4695010. https://doi.org/10.1155/2019/4695010
  4. Marshal M, Mustafa M, Crowley P, McGovern R, Ahem E, Ragab I, et. al. Misdiagnosis of myasthenia gravis presenting with tongue and palatal weakness. Oxford Medical Case Reports 2018;8:235-7. https://doi.org/10.1093/omcr/omy052
  5. Kumai Y, Miyamoto T, Matsubara K, Yamashita S, Ando Y, Orita Y. Assessment of oropharyngeal swallowing dysfunction in myasthenia gravis patiens presenting with difficulty in swallowing. Auris Nasus Larynx 2019; 46(3):390-6. https://doi.org/10.1016/j.anl.2018.10.004
  6. Liabres M, Molina FJ, Miralles F. Dysphagia as the sole manifestation of myasthenia gravis. J Neurol Neurosurg Psychiatry 2005; 76(9):1297-300. https://doi.org/10.1136/jnnp.2004.038430.
  7. Aslam M, Vaezi MF. Dysphagia in elderly. Gastroenterol Hepatol 2013;9(12):784-95.
  8. Pavel G, Niea S, Mihailescu G, Davidescu I, Anton R, Ciurea R. Myasthenia gravis-problrms in diagnosis. acase presentation. Romanian J Neurol 2013;12:40-2.
  9. Sieb JP. Myasthenia gravis: an update for the clinician. Clin Exp Immunol 2014;175(3):408-18. https://doi.org/10.1111/cei.12217
  10. Henning S, Schroeter M. SOP Myasthenia gravis. Neurol Res Pract 2019; 1:19. https://doi.org/10.1186/s42466-019-0023-
  11. Rowin J. Approach to the patients with suspected myasthenia gravis or als : a clinician’s guide. Am Acad Neurol 2009;15:13-34. https://doi.org/10.1212/01.con.0000300006.49351.2c
  12. Knuijt S, Kalf JG, Swart BJM, Drost G, Hendricks HT, Geurts ACH, et al. Dysarthria and dysfagia are highly prevalent among various types neuromuscular diseases. Disabil Rehabil 2014;36:1285-9. https://doi.org/10.3109/09638288.2013.845255
  13. Ha JC, Richman DP. Myasthenia gravis and related disorders: pathology and molecular pathogenesi. Bioch Biophys Acta 2015; 1852(4):651-7. https://doi.org/10.1016/j.bbadis.2014.11.022.
  14. Khadilar SV, Chaudhari CR, Patil TR, Desai ND, Jagiasi KA, Bhutada AG. Once myasthenic, always myasthenic? Observations on the behavior and prognosis of myasthenia gravis in a cohort of 100 patients. Neurol India 2014;62(5):492-7. https://doi.org/10.4103/0028-3886.144438.
  15. Farmakidis C, Pasnoor M, Dimachkie MM, Barohn RJ. Treatment of myasthenia gravis. Neurol Clin 2018; 36 (2): 311-7. https://doi.org/10.106/j.ncl.2018.01.011
  16. Sanders DB, Wolfe GI, Narayanaswarni P, MGFA Task Force on MG Treatment Guidance. Developing treatment guidelines for myasthenia gravis. Ann NY Acad Sci 2018; 1412(1):95-110. https://doi.org/10.1111/nyas.13537



DOI: https://doi.org/10.19106/JMedSci005203202010

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