Superimposed myasthenia gravis in chronic spinal cord injury: a case report

Study design: Case report Background/objective: Myasthenia gravis (MG) complicating spinal cord injury (SCI) is extremely rare. We report a patient with SCI developing MG leading to death. There are no similar articles at present on literature search. Case report: A 54-year-old man, paralysed at the T12 level (ASIA A) for 40 years, was admitted for surgical repair of his grade IV sacral pressure sore. During the admission he developed diplopia, fluctuating dysphagia and slurred speech. Elevated anti-acetylcholine receptor antibodies and single fibre electromyography confirmed the diagnosis of MG and pyridostigmine was commenced. His admission was complicated by intermittent episodes of unexplained tachycardia and tachypnoea. He succumbed following cardio respiratory within 6 weeks of admission. Post mortem examination was inconclusive of a definite cause of death. In the presence of SCI, it can be challenging to diagnose MG or its complications like myasthenic and cholinergic crisis. Conclusion: The case highlights the difficulty in diagnosis and management of MG in persons with SCI. Spinal Cord (2011) 49, 1206-1207; doi:10.1038/sc.2010.182; published online 21 December 2010