What should I do if myasthenia gravis is accompanied by a fever?

Written by Zhang Hui
Neurology
Updated on February 15, 2025
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Patients with myasthenia gravis are most afraid of developing a fever, as a fever may indicate an infection, especially a bacterial infection. If a bacterial infection occurs, it can easily trigger a myasthenic crisis. The patient may experience weakness in breathing and even respiratory failure, which can be life-threatening. Therefore, it is essential to address the situation promptly. The recommended approach when a fever occurs is as follows: First, quickly determine the cause of the fever, complete routine blood tests, calcitonin, and other relevant assays to confirm if it is caused by a bacterial infection. Second, symptomatically manage the fever, possibly using antipyretic medications. Third, if it is a bacterial infection, it is crucial to promptly administer a significant amount of effective antibiotics to treat it. Controlling the bacterial infection can prevent the progression of myasthenia gravis to a more severe state. (Note: Medication should be used under the guidance of a doctor.)

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What should not be eaten in the case of myasthenia gravis?

Myasthenia gravis is an autoimmune disease of the nervous system, primarily due to dysfunction at the neuromuscular junction, leading to skeletal muscle fatigue. Symptoms include drooping eyelids, double vision, overall weakness, and even swallowing difficulties. Foods that should be avoided in myasthenia gravis mainly include certain medications, such as aminoglycoside antibiotics, which should not be taken orally by patients, as well as fluoroquinolone antibiotics. These antibiotics can exacerbate neuromuscular transmission disorders, potentially worsening the disease. Additionally, benzodiazepines, barbiturates, and some anti-arrhythmic drugs can also reduce muscle membrane excitability and should be avoided.

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Myasthenia gravis should be seen in the Neurology department.

Patients with myasthenia gravis should consult the department of neurology, as myasthenia gravis is an immune-related neuromuscular junction disorder. Patients often exhibit pathological fatigue, skeletal muscle involvement, and unaffected smooth muscles. The most common type is ocular myasthenia, followed by mild and moderate generalized forms. Adult patients often have thymomas or thymic hyperplasia. Upon diagnosis of myasthenia gravis, it is essential to perform a comprehensive thymic CT scan. If thymic abnormalities are present, referral to thoracic surgery for treatment is needed. If there is no thymic disease, high-dose steroid pulse therapy may be considered. Additionally, it is crucial to determine whether the patient has other coexisting immune abnormalities, such as hyperthyroidism or connective tissue disease, and tailor the treatment accordingly.

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Can myasthenia gravis use non-invasive ventilators?

Myasthenia gravis can be treated with a non-invasive ventilator, and it is generally manageable with medication. Early stages of myasthenia gravis may present with symptoms such as ptosis, poor breathability, respiratory difficulty, worsening symptoms after activity, and increased severity in the evening. Respiratory weakness might require treatment with a non-invasive ventilator. If respiratory weakness does not improve with medication and leads to respiratory failure, it is advisable to use a non-invasive ventilator to improve the patient's symptoms and alleviate difficulties. Respiratory muscle weakness can be life-threatening and requires active treatment.

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Types of myasthenia gravis crisis

Myasthenic crises are categorized into three types, all resulting from worsening conditions or improper treatment, leading to respiratory muscle weakness or paralysis and subsequent difficulty in breathing. The first type occurs due to various triggers or reduction in medication, or after the application of acetylcholinesterase inhibitors which temporarily alleviate the crisis, known as the cholinergic crisis. The second type is a result of excessive use of acetylcholinesterase inhibitors during a cholinergic crisis. Beyond respiratory difficulties, symptoms may also include signs of toxicity such as vomiting, abdominal pain, diarrhea, pupil constriction, excessive sweating, drooling, increased tracheal secretions, and potential muscle tremors, spasms, as well as anxiety, insomnia, confusion, seizures, and coma. The third type is the paradoxical crisis, where neither ceasing nor increasing medication doses alleviates the symptoms, typically occurring after long-term, high-dose medication use.

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Types of Myasthenia Gravis Crisis

Myasthenia gravis is a neurological disease. It is an autoimmune disorder primarily affecting the neuromuscular junction, leading to symptoms such as pathological fatigue, ptosis, and limb weakness. Myasthenia gravis is termed as such due to its severe nature, including crises that can impair respiratory muscles, leading to respiratory paralysis, respiratory failure, and potentially death. There are three main types of myasthenic crises. The first type is myasthenic crisis, primarily caused by insufficient medication; muscular injections can be used for treatment, and if effective, it indicates a myasthenic crisis. The second type is called cholinergic crisis, resulting from an overdose of acetylcholinesterase inhibitors, with symptoms including muscular twitching and pupil constriction. The third type is called refractory crisis, occurring when the body is insensitive to medication treatments. All these crises pose a life-threatening risk to patients and require immediate management, including tracheal intubation and, if necessary, mechanical ventilation.