Don't Eat that Guacamole: Rare onset of Myasthenia Gravis




Mederos, Gerardo


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Myasthenia Gravis (MG) is an autoimmune disorder that targets the terminal neuro-junctional synapses in muscles leading to weakness and fatigue. Antibodies against the acetylcholine receptors result in a pure motor disorder. Here we present a patient that was diagnosed with MG after eating guacamole. Case Report Patient is a 76 year old caucasian female that presented for ptosis, right facial droop, dysarthria, and dysphagia. Patient initially developed periorbital numbness after eating guacamole at dinner. Patient was diagnosed with a food allergy and treated with prednisone and benadryl. The patient later developed right ptosis and facial droop with dysarthria requiring hospitalization. Imaging was negative for an acute cerebrovascular event, and CT chest was negative for a thymoma. Despite IV steroids her symptoms persisted. Antibodies resulted positive for MG. Patient was started on Pyridostigmine and plasma exchange. After several days of therapy she was back to her baseline function. Discussion The presentation of MG includes muscle weakness with fatigability. MG can include symptoms from mild ptosis to respiratory failure. Approximately 85% of patient's present with ocular muscle weakness. Although most patients present with mild symptoms, up to 39% of patients can have severe muscle weakness associated with dysphagia. Weakness involving the respiratory muscles can develop within 2 years of symptoms onset. In our case, 2 features are unique. First, the patient's initial symptom were periorbital swelling and numbness. MG is a pure motor disease. And second, the patient developed respiratory distress with reduced vital capacity within 72 hours of presentation.