Abstract

Myasthenia gravis is an autoimmune disease that can lead to weakness and fatigue of skeletal muscles. Here we introduce a child presenting with bulbar symptoms only.A fifteen year-old boy presented to the hospital with difficulty swallowing and speaking, and fatigue especially at evenings for one month. He could only take liquids. His neurological examination was normal. The sequential nerve stimulation test results were decreased on electromyography examination. The acetylcholine receptor antibody level was high. We considered the diagnosis of bulbar Myasthenia Gravis, and treated the patient with intravenous immunoglobulin and plasmapheresis. He was discharged with oral steroids and prydostigmin. He had frequent attacks during the follow-up and azathiprine was added to his treatment. In conclusion, pediatric patients with myasthenia gravis can apply only with bulbar symptoms

Keywords: Bulbar symptoms, Childhood, Myastenia gravis

References

  1. McGrogan A, Sneddon S, de Vries CS. The incidence of myasthenia gravis: A systematic literature review. Neuroepidemiology 2010; 34:171-83.
  2. Saltık S, Ergüven M, Turgut T, Demirbilek V, Özümüztoprak N, Doğu A. Çocukluk çağında miyasteni gravis olgu sunumu. Türk Pediatr Arş 2004;39:135-8.
  3. Arslan Y, Tokuçoğlu F, Kaya A, Ünlü GD, Zorlu Y. Geç tanı konjenital miyastenik sendrom. DEÜ Tıp Fakültesi Dergisi 2016;30:85-8.
  4. Téllez-Zenteno JF, Hernández-Ronquillo L, Salinas V, Estanol B, da Silva O. Myasthenia gravis and pregnancy: Clinical implications and neonatal outcome. BMC Musculoskelet Disord 2004;5:42.
  5. Chiang LM, Darras BT, Kang PB. Juvenile myasthenia gravis. Muscle Nerve 2009;39:423-31.
  6. Ünsal Y, Yiş U. Jüvenil miyasteni gravis: Üç olgu sunumu ve literatürün gözden geçirilmesi. J Clin Anal Med 2015;6:473-8.
  7. Ekmekci O, Karasoy H. Prepubertal juvenile myasthenia gravis; A case with early onset and bulbar symptoms. J Neurol Sci 2013;30:583-6.
  8. Sarnat H. Disorders of neuromuscular transmission and of motor neurons. In: Kliegman RM, Stanton BF, Schor NF, St. Geme JW, Behrman RE (eds). Nelson Textbook of Pediatrics. 19th ed. Philadelphia: W.B. Saunders Company, 2011:2132-8.
  9. Değerliyurt A, Şenbil N, Anlar B. Jüvenil (otoimmün ) miyasteni: Klinik özellikler ve tedavi sonuçları. Çocuk Sağ Hast Derg 2005;48:25-9.
  10. Tanrısever Ö, Sarıoğlu B, Kanık A, Arslan CN, Baydan F. Farklı bir klinik başlangıç gösteren miyastenia gravis olgusu. Tepecik Eğit Hast Derg 2014;24:59-62.
  11. Raksadawan N, Kankirawatana P, Balankura K, Prateepratana P, Sangruchi T, Atchaneeyasakul LO. Childhood onset myasthenia gravis. J Med. Assoc Thai 2002;85:769-7.
  12. Meriggioli MN, Sanders DB. Autoimmune myasthenia gravis: Emerging clinical and biological heterogeneity. Lancet Neurol 2009; 8:475-90.
  13. Ashraf VV, Taly AB, Veerendrakumar M, Rao S. Myasthenia gravis in children: A longitudinal study. Acta Neurol Scand 2006;114:19–23.
  14. Salman E, Yetişir F, Yürekli B, Bozkurt A, Kılıç M. Myastenik kriz yönetiminde intravenöz immunoglobulin tedavisi: Olgu sunumu. J Clin Anal Med 2013;4:352-4.
  15. Long RR. Myasthenia gravis in the intensive care unit. In: Irwin RS, Cerra FB, Rıppe JM (eds). Intensive Care Medicine. Philadelphia: Lippincott-Raven Publishing, 1998:2122-7.
  16. Yosunkaya A, Çelik J.B, Tuncer S, Topal A, Ökesli S. Myastenia gravis ve immunoadsorbsiyon plazmaferez. T Klin J Medl Sci 2002;22:578-82.

Copyright and license

How to cite

1.
Yılmaz A, Yalaki Z, Şen Z, Alioğlu B. A Myasthenia Gravis Case Presenting with Bulbar Symptoms. Turk J Pediatr Dis [Internet]. 2018 Apr. 1 [cited 2025 May 25];12(1):54-6. Available from: https://turkjpediatrdis.org/article/view/546