Abstract
Myasthenia gravis is an autoimmune disease that affects the neuromuscular junction. It causes generalized muscle weakness that may include the respiratory muscles, potentially leading to a medical emergency known as a myasthenic crisis. This is a case report of a rare incident of a myasthenia gravis exacerbation after administration of the oral antipsychotic risperidone to a schizophrenic patient. Few similar cases have been reported. Although rare, such incidents are dangerous as physicians could easily confuse myasthenia gravis symptoms with extrapyramidal side effects of antipsychotics. This concern should be addressed not just with risperidone but rather with any other antipsychotics that exhibit anticholinergic side effects.
Highlights
Myasthenia gravis is a rare autoimmune disorder with incidence and prevalence of 0.3-2.8 and 5.35-35 per 100,000, respectively [1]
It is caused by autoantibodies that target the postsynaptic acetylcholine receptors (AChR) in the neuromuscular junction, leading to muscle weakness and fatigability, and could lead to a lifethreatening myasthenic crisis with respiratory depression that requires urgent assisted ventilation [2]
Antipsychotic medications are the mainstay of the management of schizophrenia and many agents in this drug class are with varying degrees of anticholinergic side effects [4]
Summary
Myasthenia gravis is a rare autoimmune disorder with incidence and prevalence of 0.3-2.8 and 5.35-35 per 100,000, respectively [1]. Antipsychotic medications are the mainstay of the management of schizophrenia and many agents in this drug class are with varying degrees of anticholinergic side effects [4] In this rare occasion of comorbid myasthenia gravis in a patient with psychotic disorder needing antipsychotics for management, serious exacerbations could be life-threatening causing severe respiratory depression due to the depletion of the neurotransmitter acetylcholine stores in critical sites across the body’s neuromuscular junctions such as the intercostal and diaphragmatic muscles [2]. Plasmapheresis was started, after which dysphagia and nasal speech improved He continued on olanzapine 7.5 mg oral daily with good response, and due to him being drug-naive, he needed a small dose to control his behavior and had no signs of deterioration or exacerbation of myasthenia gravis. Neurology team's final impression was myasthenia gravis, and the patient is receiving collaborative care between psychiatry and neurology
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