title: Postoperative myasthenic crisis successfully treated with immunoadsorption therapy.
abstract: Myasthenia gravis (MG) is an autoimmune disorder characterized by loss of acetylcholine receptors (AChR) due primarily to the production of anti-AChR autoantibodies. We report a case of MG associated with elevated anti-acetylcholine receptor antibody (anti-AChR Ab) and refractory crisis after thymectomy, in which immunoadsorption therapy was used successfully to stabilize myasthenic symptoms and decrease the anti-AChR Ab titer. A 79-year-old woman underwent extended thymectomy under the diagnosis of MG. One day after surgery she suddenly underwent a myasthenic crisis and was successfully resuscitated. Immunoadsorption therapy with a tryptophan-linked polyvinyl alcohol adsorber was performed three times for the purpose of decreasing the anti-AChR antibodies. The anti-AChR Ab titer was reduced by immunoadsorption during each therapy session; however, the level of anti-AChR Ab before immunoadsorption was higher than that of the previous treatment. This case suggests that the absolute serum level of anti-AChR Ab does not always correlate with the severity of the disease. Removal of pathogenic factors, not only anti-AChR Ab but other antibodies with specificities to skeletal muscles or certain components of the complement system, may contribute to effective treatment of myasthenic crisis.
authors.affiliation: Department of Anesthesiology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi 371-8511, Japan.
authors.forename: Junko
authors.initials: J
authors.lastname: Ishizeki
authors.forename: Koichi
authors.initials: K
authors.lastname: Nishikawa
authors.forename: Fumio
authors.initials: F
authors.lastname: Kunimoto
authors.forename: Fumio
authors.initials: F
authors.lastname: Goto
mesh_terms: D000368:Aged; D001323:Autoantibodies / Q000097:blood*; D005260:Female; D006323:Heart Arrest / Q000209:etiology / Q000628:therapy; D006801:Humans; D007163:Immunosorbent Techniques; D009157:Myasthenia Gravis / Q000097:blood / Q000628:therapy*; D011142:Polyvinyl Alcohol; D011183:Postoperative Complications / Q000628:therapy*; D011950:Receptors, Cholinergic / Q000276:immunology; D013934:Thymectomy; D016896:Treatment Outcome; D014364:Tryptophan
chemical_list: D001323:Autoantibodies; D011950:Receptors, Cholinergic; D014364:Tryptophan; D011142:Polyvinyl Alcohol