Téma: Case studies

Severe exacerbations of myasthenia gravis in pregnancy and puerperium – case report

Ivan Martinka, Peter Špalek

Myasthenia gravis (MG) is an autoimmune disorder of neuromuscular junction, which manifests itself with fluctuating
muscle weakness, abnormal fatiguability and physical effort intolerance. Pregnancy and puerperium can affect the
course of MG. Women with MG should be monitored during pregnancy in specialized centers that have neurologists,
obstetricians and neonatologists with sufficient knowledge and experience in this field.
In females with long-term clinical or pharmacological remission MG exacerbations during pregnancy are a rarity. In cases
of manifest MG the clinical symptoms during pregnancy usually diminish or even disappear, particularly in the third
trimester. The risk of MG exacerbations during pregnancy is low. They usually occur in the first trimester and are not
severe. On the other hand, the risk of MG exacerbations increases dramatically after delivery (in puerperium), particularly
in females with manifest MG during pregnancy. The treatment of choice for MG exacerbations during pregnancy
is prednisone, in MG exacerbations after delivery a combined oral immunosuppressive therapy (azathioprine, prednisone)
is essential. If the effect of first line therapy is insufficient or in case of severe MG exacerbations or myasthenic
crises, the intravenous immunoglobuline (IVIg) combined with immunosuppressive therapy is necessary. If severe MG
exacerbations in puerperium are expected, mainly in females with manifest MG during the whole pregnancy, the preventive
use of IVIg after delivery can be considered.
In our article we present a rare case report of a woman with MG in long-term clinical remission before pregnancy, who
experienced severe MG exacerbations during pregnancy and in puerperium, both exacerbations required immunotherapy
with IVIg.

Ročník 2017  Témy časopisu Neurology 1 / 2017

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