Respiratory dysfunction as first presentation of myasthenia gravis misdiagnosed as COVID-19
- PDF / 666,329 Bytes
- 3 Pages / 595.276 x 790.866 pts Page_size
- 91 Downloads / 147 Views
COVID-19
Respiratory dysfunction as first presentation of myasthenia gravis misdiagnosed as COVID-19 Giuseppe Scopelliti 1
&
Maurizio Osio 2
&
Massimo Arquati 3 & Leonardo Pantoni 1,2
Received: 6 September 2020 / Accepted: 10 October 2020 # Fondazione Società Italiana di Neurologia 2020
Abstract Background The outbreak of the coronavirus disease 2019 (COVID-19) has had profound impact on health care not only for its direct effects, but also because it deeply influenced the whole clinical practice and diagnostic pathways, particularly in the acute setting. Case report We present the case of a patient with respiratory dysfunction due to myasthenia gravis (MG) initially misdiagnosed as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection due to ambiguity in the interpretation of radiological and microbiological findings during COVID-19 pandemic. Discussion Respiratory dysfunction as first clinical manifestation of myasthenia gravis is rare, but potentially very harmful. Emergency physicians should always consider neurological diseases when dyspnea cannot be explained by cardiac or respiratory causes. Keywords COVID-19 . SARS-CoV-2 . Myasthenia gravis . Dyspnea . Emergency medicine
Introduction The coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) is a sanitary emergency that has required massive public health efforts and introduced new diagnostic and therapeutic challenges in the everyday practice. Here, we present the case of a patient with fluctuant dyspnea as first presentation of seronegative myasthenia gravis (MG) that was initially misdiagnosed as COVID-19 for his respiratory disturbances.
Case report A 46-year-old man, with hypertension and past history of cigarette smoking, presented to the emergency department (ED) on March 26 for symptoms consistent with upper respiratory infection (cough, sore throat, and fever). The patient had been put on * Leonardo Pantoni [email protected] 1
“Luigi Sacco” Department of Biomedical and Clinical Sciences, University of Milan, Via Giovanni Battista Grassi 74, 20157 Milan, Italy
2
Neurology Unit, Ospedale Luigi Sacco, Milan, Italy
3
Emergency Medicine, Ospedale Luigi Sacco, Milan, Italy
azithromycin by the general practitioner 3 days before the presentation in the ED. Polymerase chain reaction (PCR) assay on nasal-pharyngeal swab sample was negative for SARS-CoV-2, while a chest X-ray was reported as suggestive for mild interstitial pneumonia. Thus, the patient was hospitalized in a COVID19 ward and eventually discharged 3 days after, afebrile and without signs of respiratory dysfunction. The diagnosis at discharge was “mild SARS-CoV-2-related pneumonia.” A few days after discharge, the patient suffered from shortness of breath, generalized weakness, and marked effort intolerance. Moreover, he occasionally found low values of arterial oxygen saturation on self-measurement at home (O2 saturation swinging from 91–97% over the day). For this reason, he presented to ED a
Data Loading...
