title: Case of severe refractory myasthenia gravis in HUKM.
abstract: A 20-year-old girl first notice bilateral ocular muscle weakness in 2001. Two months later, she developed acute muscle paralysis and respiratory failure which required ventilation. Serum anti-acetylcholine receptor antibodies and repetitive nerve stimulation test was positive and consistent with myasthenia gravis (MG). CT scan thorax revealed thymic enlargement and she underwent a video assisted thymectomy (VATS). However, over the next three years, despite maximal doses of various immunosuppressive agents with plasmapheresis and intravenous immunoglobulin, she was admitted with recurrent myasthenic crisis without any obvious precipitant. She was then commenced on mycophenolate mofetil and together with regular plasmapheresis, cyclosporine and prednisolone, her symptoms have finally improved and brought under control.
authors.affiliation: Department of Medicine, Hospital UKM, Jalan Yaacob Latiff, Bandar Tun Razak 56000, Kuala Lumpur.
authors.forename: R
authors.initials: R
authors.lastname: Hamizah
authors.forename: M I
authors.initials: MI
authors.lastname: Norlinah
authors.forename: H J
authors.initials: HJ
authors.lastname: Tan
authors.forename: Z
authors.initials: Z
authors.lastname: Soehardy
authors.forename: A G
authors.initials: AG
authors.lastname: Halim
authors.forename: A G
authors.initials: AG
authors.lastname: Rohana
authors.forename: B B
authors.initials: BB
authors.lastname: Hamidon
authors.forename: N C T
authors.initials: NC
authors.lastname: Kong
authors.forename: A A
authors.initials: AA
authors.lastname: Raymond
mesh_terms: D000328:Adult; D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007136:Immunoglobulins / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D009157:Myasthenia Gravis / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D010956:Plasmapheresis; D011239:Prednisolone / Q000627:therapeutic use; D013934:Thymectomy
chemical_list: D007136:Immunoglobulins; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D011239:Prednisolone; D009173:Mycophenolic Acid