Critical Care and Shock

Postoperative myasthenia crisis (PMC) after thymoma debulking surgery



Background: Debulking surgery is a common procedure performed in myasthenia gravis due to invasive thymoma. Postoperative myasthenia crisis is a life-threatening complication that can occur after this procedure even though plasma exchange has been given before.

Case presentation: We present a case report of a 44-year-old male who was diagnosed with myasthenia gravis due to thymoma and performed debulking surgery. He had progressive respiratory failure and he was diagnosed with myasthenia crisis. Because of limited resources and cost, we treated the patient with combination therapy of 3 cycles plasma exchanged and steroids over 8 days. The patient recovered and was successfully extubated on day 10 and discharged from the Intensive Care Unit (ICU) on day 12 postoperative.

Conclusion: Some of the therapeutic strategies, in this case, provided modulating therapy, overcoming infections, oxygen therapy, and adequate nutrition. Plasma exchange and intravenous immunoglobulin (IVIg) are the therapeutic standard modalities for myasthenia crisis. In conditions where it is not able to provide optimal plasma exchange, therapy can be combined with steroid administration, although until now steroid administration is still controversial.

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