Crisis averted: a patient in cardiopulmonary arrest

Abstract

Neuromuscular diseases are rare causes of acute hypercapnic respiratory failure due to respiratory muscle weakness and can be life-threatening if not recognized. We report a case of a 35-year-old man with worsening dyspnea, non-productive cough, and fever presenting in cardiopulmonary arrest requiring intubation and mechanical ventilation. After work-up for neuromuscular disease with a positive acetylcholine receptor antibody test, the source of his respiratory failure was discovered to be myasthenia gravis. He improved with acetylcholinesterase inhibitors, corticosteroids, and plasmapheresis therapy but had a long complicated hospital course. Computed tomography of the chest with intravenous contrast revealed an anterior mediastinal mass, which was later resected and confirmed to be a thymoma.

Keywords

• myasthenia gravis
• respiratory failure
• thymoma