Mustaq Adnan1, Mehedi Hasan1, H.M.Aminur Rashid1, Syed Nesar Ahmed2, Bulbul Parveen2, Md. Khairul Hassan Jessy3, Mohammad Ashik Imran Khan2, ASM Fateh Akram4

Abstract
Myasthenia gravis is an extremely rare disorder. It may present uniquely with ocular symptoms or it may
present with ocular, bulbar and respiratory symptoms. 15-20% of patients with myasthenia gravis are
affected by myasthenic crisis at least once in their life time. Here, we present a case of a 24 years old lady
diagnosed as myasthenia gravis who initially presented with predominant ocular symptoms but later
developed myasthenic crisis dominated by respiratory symptoms. She was found to have thymoma and
developed cholinergic crisis following thymectomy. Myasthenia gravis and myasthenic crisis are relatively
rare disorders. Presentation can range from ocular through generalized to respiratory failure. This case
highlights the importance of considering neuromuscular disorders in patients presenting with respiratory
failure due to myesthenic crisis and managing this by keeping a safe balancing distance with cholinergic
crisis.
Keywords: Myasthenia Gravis, Myasthenic Crisis, Cholinergic Crisis, Acetylcholinesterase Inhibitors
Abbreviations: ICU= Intensive Care Unit, ABG= Arterial Blood Gases, MG= Myasthenia gravis, MC=
Myasthenic crisis, CT= Computed Tomography, AChR= Acetylcholine Receptor, FNAC= Fine Needle
Aspiration Cytology, ET= Endo-tracheal , IVIG= Intravenous Immunoglobulin

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