Anesthetic Management of a Patient With Antimuscle-Specific Kinase Antibody-Positive Myasthenia Gravis Undergoing an Open Cholecystectomy: A Case Report

Myasthenia gravis (MG) is an autoimmune disease characterized by the production of antibodies against the acetylcholine receptor, muscle-specific kinase (MuSK), or other proteins at the neuromuscular junction. MG with antibodies against MuSK (MuSK-MG) has been described recently. Here, we report the first case of anesthetic management of a patient with MuSK-MG undergoing an open cholecystectomy. In our case, propofol and remifentanil-based anesthesia were used for successful management without using muscle relaxants. Patients with MuSK-MG have predominantly ocular, bulbar, and respiratory symptoms that may increase the risk of aspiration. Anesthesiologists need to pay attention to perioperative respiratory failure and respiratory crisis.
Source: A&A Case Reports - Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

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This article reviews the basic and advanced treatment options of the different disease subtypes including plasma exchange and immunoglobulins for treatment in a myasthenic crisis. Recently, clinical approval of eculizumab, a complement inhibitor, enriched the pharmacological armamentarium for AChR antibody-positive MG patients not appropriately responding to immunosuppression alone. PMID: 31538208 [PubMed - as supplied by publisher]
Source: Der Nervenarzt - Category: Neurology Authors: Tags: Nervenarzt Source Type: research
Myasthenia gravis (MG) is a rare and treatable antibody-mediated autoimmune disease. Pseudo internuclear ophthalmoplegia (-INO) or pyramidal tract damage is rarely observed in MG, and there were no known cases of MG with both pseudo-INO and pyramidal tract damage. Here, we report a case of a 61-year-old female suffering from MG accompanied by pseudo-INO and pyramidal tract damage with a rapid progressive course. Her blood and cerebrospinal fluid (CSF) tests were normal, except for the presence of the anti-acetylcholine receptor antibody. CT and contrast enhancement of the chest showed a thymic involution. MRI and contrast ...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
Myasthenia gravis (MG) is an autoimmune disorder caused by antibodies targeting the neuromuscular junction, which in most cases are directed towards the skeletal muscle acetylcholine receptor (AChR) [1]. The pathophysiology of MG is accepted to be immune mediated [2]. Sporadic inclusion body myositis (IBM) is considered the most common inflammatory myopathy in patients over 50 years old, but its pathophysiology remains to this day an enigma: It is still unclear whether it is a primary degenerative disease with secondary dysimmune reaction or vice versa [3].
Source: Neuromuscular Disorders - Category: Neurology Authors: Tags: Case report Source Type: research
Conclusions: Rituximab is both safe and effective for the treatment of acquired angioedema with C1-inhibitor deficiency, ANCA-associated vasculitis, autoimmune hemolytic anemia, Behçet’s disease, bullous pemphigoid, Castleman’s disease, cryoglobulinemia, Goodpasture’s disease, IgG4-related disease, immune thrombocytopenia, juvenile idiopathic arthritis, membraneous nephropathy, relapsing-remitting multiple sclerosis, myasthenia gravis, nephrotic syndrome, neuromyelitis optica, pemphigus, rheumatoid arthritis, spondyloarthropathy, and systemic sclerosis. Conversely, rituximab failed to show an effec...
Source: Frontiers in Immunology - Category: Allergy & Immunology Source Type: research
AbstractThe complement system is a powerful member of the innate immune system. It is highly adept at protecting against pathogens, but exists in a delicate balance between its protective functions and overactivity, which can result in autoimmune disease. A cascade of complement proteins that requires sequential activation, and numerous complement regulators, exists to regulate a proportionate response to pathogens. In spite of these mechanisms there is significant evidence for involvement of the complement system in driving the pathogenesis of variety of diseases including neuromyelitis optica spectrum disorders (NMOSD) a...
Source: Journal of Neurology - Category: Neurology Source Type: research
CONCLUSION: Our findings suggest that Th cells and their cytokines balance of MG patients are involved in the clinical condition or severity of MG disease. PMID: 31453784 [PubMed - as supplied by publisher]
Source: Current Molecular Medicine - Category: Molecular Biology Authors: Tags: Curr Mol Med Source Type: research
In conclusion, the above results indicate that metformin may have therapeutic value for the clinical treatment of MG. PMID: 31437793 [PubMed - as supplied by publisher]
Source: International Immunopharmacology - Category: Allergy & Immunology Authors: Tags: Int Immunopharmacol Source Type: research
Here we describe a 79 years old man admitted to our unit for worsening diplopia and fatigue, started a few weeks after an episode of bronchitis and flu vaccination. Past medical history included myasthenia gravis well controlled by Pyridostigmine, Azathioprine and Prednisone. During the first days, the patient developed progressive ocular movement abnormalities up to complete external ophthalmoplegia, severe limb and gait ataxia and mild dysarthria. Deep tendon reflexes were absent in lower limbs. Since not all the symptoms were explainable with the previous diagnosis of myasthenia gravis, other etiologies were investiga...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
Publication date: Available online 9 August 2019Source: Autoimmunity ReviewsAuthor(s): Adrian W. Zuercher, Rolf Spirig, Adriana Baz Morelli, Tony Rowe, Fabian KäsermannAbstractIn recent years, there has been a surge in the research and development of novel molecules as potential therapeutic alternatives to traditional treatments (such as intravenous immunoglobulins) for autoimmune disorders. The aim of this review is to describe different drug development strategies and evaluate how various molecules have performed in clinical trials to date. Broadly, three main approaches have been pursued. Recombinant fragment cryst...
Source: Autoimmunity Reviews - Category: Allergy & Immunology Source Type: research
Conclusion: Existing research provides evidence revealing a spectrum of antibodies linked to the development and progression of neurological diseases. However, further antibody testing and studies should be performed to validate the relationship between conditions and antibodies. PMID: 31380113 [PubMed]
Source: Autoimmune Diseases - Category: Allergy & Immunology Tags: Autoimmune Dis Source Type: research
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