Postpartum Myasthenic Crisis in a Patient with SLE: A Case Report and Literature Review

Abstract

Background: Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease characterized by the presence of numerous auto-antibodies while Myasthenia Gravis (MG) is an organspecific autoimmune disease. The coexistence of both diseases is rarely reported in the literature. Case presentation: We report a case of a 29-year-old female SLE patient with chief manifestations of nephritis, inflammatory polyarthritis and cytopenia presented with postpartum shortness of breath and dysphagia requiring emergency intubation and difficulty in weaning. Later she developed chronic respiratory acidosis with bilateral ptosis. Her diagnosis of myasthenia was confirmed with a positive neostigmine test and nAChR antibodies. She was given 5 cycles of PLEX and pyridostigmine with significant improvement of symptoms and extubated safely. Conclusion: It is one of the rare case reports of SLE preceding MG with significant improvement by anticholinergic therapy