A 27-year-old woman presents with fatigue and double vision. The patient reports that these symptoms occur at the end of a “long work day.” The patient also reports that she does not eat “tough” foods anymore such as steak or chicken as it is difficult for her to chew. Neurologic examination is unremarkable and the patient has normal thyroid-stimulating hormone (TSH) and creatine kinase (CK) levels. The diagnosis is confirmed with a special laboratory test. Which of the following is the next best step in management of this patient?
Question
A 27-year-old woman presents with fatigue and double vision. The patient reports that these symptoms occur at the end of a “long work day.” The patient also reports that she does not eat “tough” foods anymore such as steak or chicken as it is difficult for her to chew. Neurologic examination is unremarkable and the patient has normal thyroid-stimulating hormone (TSH) and creatine kinase (CK) levels. The diagnosis is confirmed with a special laboratory test. Which of the following is the next best step in management of this patient?
Solution
The patient's symptoms suggest a diagnosis of Myasthenia Gravis (MG), a neuromuscular disorder that causes weakness in the skeletal muscles. The symptoms often worsen after periods of activity and improve after rest, which aligns with the patient's report of symptoms occurring at the end of a long work day. Difficulty in chewing and swallowing can also be a symptom of MG.
The next best step in management would be to start the patient on an acetylcholinesterase inhibitor such as pyridostigmine. This medication increases the concentration of acetylcholine at the neuromuscular junction, improving muscle strength.
In addition, the patient should be referred to a neurologist for further management and monitoring. Long-term treatment options for MG include immunosuppressive drugs and thymectomy. The patient should also be educated about the nature of the disease, the importance of medication compliance, and the need to avoid triggers that can exacerbate symptoms.
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