Myasthenia gravis exacerbation after cetirizine administration.

摘要

A 22-year-old woman presented with a 6-month history of proximal muscle weakness, dysphagia, and weakness of jaw closure in December 1992. Neurological examination revealed nasal speech, weakness of proximal muscles of upper and lower limbs (4/5), and bilateral "Bell sign." Ptosis and diplopia were apparent after a fatigability test. The serum acetylcholine receptor binding antibody titer was elevated. Repetitive nerve stimulation at 3 Hz with recording from abductor dig-iti minimi and nasalis induced decremental responses of 18% and 31%, respectively. Chest tomography showed both enlarged and small nodular lesions without contra'st enhancement in the thymus gland. The patient had symptomatic improvement in response to treatment with pyridostigmine (60 mg every 8 h) over the next 10 days. At the time of discharge, she was asymptomatic. The thymus gland was removed 20 days later and was found to have follicular hyperplasia. This patient would be classified as IIIb according to the Myasthenia Gravis Foundation of America (MGFA) clinical classification.