A 55-year-old man, allergic to tetras and beta-lactamic component associated with a history of hypertension, was followed up at the Chronic Pain Unit due to a clinical picture of left lower back pain and malaise
Medical treatment was established with tramadol, pregabalin and standard doses of duloxetine. Diagnosis was established with local anesthetic and deep muscle corticoids (left lumbar spine and square).
After a clinical improvement of more than 50%, the patient was scheduled for a new incident, according to the hospital protocol, of the psoas muscles and left lumbar square, with botulinum toxin type A (Dysport®) 200 IU per muscle in one session.
Four months later, the patient developed a self-limiting episode of ptosis vulgaris without consulting for it.
Since then, the patient reported episodes of ptosis, which improved after local anesthetic and corticoids trigger points on the shoulder girdle.
Six months later, the patient developed a clinical picture of ptosis associated with diplopia and mandibular weakness. She consulted and studied the Neurology Department of the hospital and was diagnosed with steroid myasthenia gravis.
