Impending Myasthenic Crisis in a Patient with Generalized Myasthenia Gravis: A Case Report

Abstract

Impending myasthenic crisis represents an early but potentially life-threatening deterioration in patients with myasthenia gravis, marked by increasing weakness of the respiratory and bulbar muscles before frank respiratory failure occurs. Prompt recognition and treatment are essential to avoid intubation and prolonged intensive care. This case report describes a 42-year-old woman with previously diagnosed generalized myasthenia gravis who developed progressive ptosis, dysphagia, nasal quality of speech, neck weakness, and exertional breathlessness following an upper respiratory infection. Clinical examination, pulmonary function assessment, repetitive nerve stimulation, and positivity for acetylcholine receptor antibodies confirmed an impending crisis. She was managed in the intensive care unit with intravenous immunoglobulin, anticholinesterase therapy, corticosteroids, antibiotics, and serial monitoring of respiratory function. Her symptoms improved substantially within five days, and ventilatory support was not required. The report underlines the importance of identifying early warning signs and initiating multidisciplinary intervention before respiratory collapse develops.