The symptoms began two years ago with intermittent diplopia and ptosis, resulting in the diagnosis of myasthenia gravis positive for anti-acetylcholine receptor (AChR) antibodies and initiation of treatment with the acetylcholinesterase inhibitor pyridostigmine. However, a few months later, symptoms worsened, including complete oculomotor paresis in both eyes, swallowing difficulties, and generalized fatigability, indicating generalized myasthenia gravis. Azathioprine and intravenous immunoglobulins were introduced, but neither treatments sufficiently improved the clinical condition. Subsequently, treatment with glucocorticoids was initiated, resulting in a slight improvement in the myasthenia gravis symptoms. Unfortunately, the symptoms worsened when the glucocorticoid dosage was reduced. Due to the limited efficacy of the previous treatments, the patient was treated with efgartigimod.
- Past medical history:
Type 2 diabetes for 15 years, managed with sitagliptin/metformin, gliclazide and insulin glargine. - Surgical history:
Surgeries for a hip fracture, left elbow dislocation, and left radial head fracture resulting from a ladder fall 19 years ago. - Family history
His sister has Type 2A von Willebrand disease. - Travel history
None - Social history
Divorced
Living alone
No children - Medication:
Pyridostigmine 420 mg/day
Azathioprine 200 mg/day
Prednisone initiated at 80 mg/day and reduced to 20 mg/day
Intravenous immunoglobulins every 6 weeks
