A CASE REPORT OF INTENSIVE CARE MANAGEMENT OF REFRACTORY MYASTHENIA GRAVIS WITH ACUTE RESPIRATORY FAILURE: DIAGNOSIS, TREATMENT AND MANAGEMENT

Myasthenia gravis is an autoimmune disorder causing muscle weakness and fatiguability due to the antibody against acetylcholine receptor. The disease is characterised by frequent relapse and remission and respiratory distress resulting in myasthenic crisis. Management of disease revolves around suppression of symptoms and disease pathology. Treatment options include acetylcholinesterase inhibitors, steroids, immunosuppressants and plasma exchange therapies. We present a case of 24-year-oldfemale with a known case of myesthenia gravis who showed failure to conventional therapy with pyridostigmine, steroids and IVIG. She received 5 cycles of PLEX to overcome the myesthenic crisis followed by rituximab. She was kept on a maintainence dose of steroids and immunosuppressants. Her course in icu was stormy with respiratory distress requiring intubation and mechanical ventilation and development of VAP. She was extubated after 4 cycles of PLEX and VAP management.