Deceptive Dyspnea: A Dual Pathology of Myasthenia Gravis and Right-to-Left Shunt Masquerading As Status Asthmaticus
Abstract
Respiratory failure in myasthenia gravis (MG) can mimic refractory status asthmaticus, leading to misdiagnosis and delayed treatment. We present the case of a 28-year-old female with a history of asthma and a known partial atrioventricular canal defect who was admitted with acute respiratory failure and severe hypoxemia, not responsive to maximum bronchodilator and corticosteroid therapy. Fatigable weakness on bedside examination led to a diagnosis of seropositive generalized MG. Although treated with pyridostigmine and intravenous immunoglobulin to improve her muscle strength, the persistence of severe hypoxemia suggested an underlying pathology. Bubble contrast echocardiography then confirmed a right-to-left shunt via her cardiac defect, along with mild pulmonary hypertension, and thus a double pathophysiology for her respiratory failure. It highlights that a failure of the patient to improve as anticipated should prompt diagnostic reassessment to prevent anchoring bias, and it underscores the crucial role of contrast echocardiography in identifying disproportionate hypoxemia in patients with an underlying cardiac shunt.
How strong is the evidence?
Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
Read the paper
Related studies
- Drug repositioning: a brief overview
- Cyclic nucleotide phosphodiesterases in Drosophila melanogaster
- Time-resolved in silico modeling of fine-tuned cAMP signaling in platelets: feedback loops, titrated phosphorylations and pharmacological modulation
- Current View on Green Tea Catechins Formulations, Their Interactions with Selected Drugs, and Prospective Applications for Various Health Conditions
- In silico Structure-based Identification of Novel Acetylcholinesterase Inhibitors Against Alzheimer’s Disease
- Development and In Vitro Evaluation of Controlled Release Viagra® Containing Poloxamer-188 Using Gastroplus™ PBPK Modeling Software for In Vivo Predictions and Pharmacokinetic Assessments
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.