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Pancytopenia and cavitatory pneumonia: case report A 40-year-old woman developed pancytopenia and cavitatory pneumonia during treatment with azathioprine and unspecified steroids for myasthenia gravis (MG) with hypokalemic periodic paralysis (HPP). The woman with one week history of generalised weakness, decreased oral intake and sudden onset of shortness of breath presented to emergency department. Due to severe respiratory distress, she was intubated in emergency department and shifted to ICU. Differential diagnosis included hypokalemic periodic paralysis secondary to underlying renal tubular acidosis. Hence, she started receiving IV potassium replacement and later oral potassium citrate was added to her regimen. On day 3 of admission, she failed a trial of extubation and had to be re-intubated due to type II respiratory failure. Subsequently, she was diagnosed with myasthenia gravis and started receiving pulse IV steroids, pyridostigmine and plasmapheresis. After three sessions of plasmapheresis, she was successfully extubated; however, required non-invasive mechanical ventilation for few days post-extubation. Finally, she was discharged on oral steroids 30mg two times per day, azathioprine 50mg two times per day [route not stated] and pyridostigmine. Her condition improved but she continuously required potassium chloride. She was finally diagnosed with MG and HPP. After 6 weeks of discharge, she was readmitted with azathioprine and steroids-induced pancytopenia and cavitatory pneumonia. Unfortunately, the woman died of septic shock and severe respiratory failure. Author comment: " [T]he patient was readmitted with drug-induced pancytopenia and cavitatory pneumonia". Khan FG, et al. Coexistence of myasthenia gravis with hypokalemic periodic paralysis: A rare presentation. BMJ Case Reports 12: No. 10, 2019. Available 803436141 from: URL: http://doi.org/10.1136/bcr-2019-231241 - Pakistan

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Reactions 30 Nov 2019 No. 1781