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2015, Number 1

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Med Crit 2015; 29 (1)

Plasmapheresis in myasthenia gravis and pregnancy

Briones-Vega CG, Viruez-Soto JA, Vallejo-Narváez CM, Tórrez-Morales F, Briones-Garduño JC, Díaz de León-Ponce MA

Language: Spanish
References: 20
Page: 46-49
PDF size: 219.29 Kb.


ABSTRACT

Introduction: The estimated prevalence of myasthenia gravis (MG) lays in 1 in 50,000, with 2/3 of affected individuals being female. Commonly women in their second and third decades of life, hence their reproductive years are affected. The outcome of pregnancy is unpredictable. Plasmapheresis has been reported as safe during pregnancy especially when a short-time benefit is needed. The objective is to expose a myasthenia gravis case during pregnancy, treated successfully with plasmapheresis.
Case report: 18 year-old patient, with diagnoses of myasthenia gravis 2 weeks after her last menstrual period, gestation is confirmed at 8 weeks of amenorrhea, at 29 weeks presents myasthenic crisis type Osserman IIB with QMGS of 28 points with cuadriparesia, diplopia and bulbar signs. Plasmapheresis is initiated with 5 interchanges of 1,300 mL, under strict maternal fetal monitorization, after that the QMGS diminishes to 9 points and the patient is discharged with a pregnancy of 30.5 weeks with treatment based on piridostigmine and prednisone.
Discussion: It becomes interesting to mention that in this case the diagnoses of myasthenia gravis and pregnancy were made almost at the same time. It is worth mention the usefulness of plasmapheresis in this pathology during pregnancy, being high risk pathology with unpredictable course, in particular with respiratory insufficiency risk, with danger for the mother as for the fetus. As women are affected in their reproductive years, it is important to be aware of this condition and its interdisciplinary management.


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