Antibiotic-induced relapse of nonthymomatous myasthenia gravis with previously post-thymectomy complete remission

Abstract

Myasthenia Gravis (MG) is an autoimmune disorder of neuromuscular transmission with a potentialy devastating outcome if not treated carefully. Thymectomy has been long proposed as one promising treatment option with better clinical outcome even in nonthymomatous myasthenia gravis group. Despite the complete remission condition after thymectomy, patients are still at risk of relapse events, in which several drugs, including types of antibiotics have been associated with its induction or exacerbation. To present a case of successfully treated antibiotics associated relapse in post-thymectomy nonthymomatous Myasthenia Gravis patient who previously has achieved complete remission. A 15-year-old male presented with complaints of progressive double vision, bilateral ptosis, and fluctuating general weakness. No thymoma or other mediastinal mass were found on chest CT scan. His symptoms showed only slight improvement and his condition deteriorate despite treatment given. He then underwent plasma exchange and total thymectomy in which he achieved complete remission for four years. He returned with his original complaints after taking cefixime and clindamycin. Our examinations yield no possible other causes that may become his relapse trigger. He was then stopped from his antibiotics and treated with pyridostigmine 120 mg daily for two consecutive months and once again achieved complete remission without further medication. Medication in patient with Myasthenia Gravis should be carefully considered even in patients who have achieved complete remission as induction and exacerbation may still be possible.