えん下困難で判明した重症筋無力症例

Abstract

Dysphagia is generally classified into two types, static and dynamic disorders, depending on the cause. Usually, dysphagiais caused by static disorders such as pharyngo-esophageal stenosis or esophageal obstruction caused by tumors or foreign bodies. In contrast, it is unusual to see patients with dysphagia related to dynamic disorders such as neurologic or muscular diseases. We present here a patient with myasthenia gravis whose chief complaint was dysphagia. The patient was a 71-year-old female who complained of dysphagia immediately after meals, and was suspected to have a foreign body in her esophagus. Upon examination at our department, no esophageal foreign bodies were observed by endoscopy, but fluoroscopic examination using a contrast medium showed an abnormality in the hypopharynx. After hospitalization for further investigation, she suddenly developed aspiration pneumonia and respiratory arrest. Her lung function was improved by ventilation. Based on these events, a systemic neurological disorder underlying herdysphagia was strongly suspected. After referral to a neurologist, the patient was diagnosed with myasthenia gravis 12 days after her hospitalization.