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Case Reports 2018 Medical Case Reports
ISSN: 2471-8041 Page 44
May 28-29, 2018
London, UK
8th Edition of International Conference on
Clinical and Medical Case Reports
A54-year-old man with chronic exposure to carbamates and
organophosphateswas referred fromthe otorhinolaryngology
outpatient section in 2014, because of 3 years of dyspnea
and dysphonia of spasmodic features, phonasthenia without
respiratory distress or dysphagia; associated to progressive
weakness in lower limbs. Brain magnetic resonance,
angioresonance and chest x-ray had no alterations; laryngeal
electromyography revealed a bilateral neuropathic pattern
without denervatory activity, with some signs of reinnervation
and decreased recruitment. Lambert test displayed motor and
sensory distal latencies of median nerves prolonged. Repetitive
stimulation test evidenced a decrease greater than 10% in the
trapezium, concluding an abnormal repetitive stimulation test,
concluding a conduction disorder in the neuromuscular junction.
With a diagnostic impression of myasthenia gravis, the patient
started a therapeutic test with pyridostigmine worsening the
symptoms,sohewasswitchedtoazathioprineandcorticosteroids.
His anti-MuSK antibodies <0.05 mmol/L and antibodies against
acetylcholine receptors <15% were interpreted as negative.
Due to worsening of the bulbar symptoms, plasmapheresis
was performed; after the first session he showed improvement
in lower limbs weakness, so five sessions were carried out
with continuous improvement. Myasthenia gravis and its
subcategories are major diseases that affect the neuromuscular
junction. The diagnosis is confirmed by the combination of
relevant symptoms and signs, neurophysiological studies and a
positive test for specific autoantibodies. About 10% of patients
with generalized myasthenia gravis do not have detectable
antibodies to acetylcholine receptors or muscle specific kinase
(MuSK) (double seronegative myasthenia), so neurophysiological
tests and a positive response to therapy secure the diagnosis.
Biography
Gustavo Pradilla is a Colombian native who finished his medical training
with honours in the first class of medicine at the Universidad Industrial de
Santander (UIS) in Bucaramanga. He did his neurology residency at the Uni-
versidad Javeriana in Bogotá, later returned to his almamater and was dean
of the faculty of health. Currently he is a UIS medicine laureate professor
and head of the neurology service at the Hospital Universitario de Santander
Double seronegative myasthenia gravis: a case report
Linda Carolina Jaramillo, Jenny Paola Garzón and Gustavo Pradilla
Industrial University of Santander, Colombia
Linda Carolina Jaramillo et al., Med Case Rep. 2018, Volume 4
DOI:10.21767/2471-8041-C1-002