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Coronary spastic angina after the administration of intravenous immunoglobulin in myasthenia gravis: a case report

BACKGROUND: Myasthenia gravis (MG) is an autoimmune disease caused by antibodies that block or destroy nicotinic acetylcholine receptors at the neuromuscular junction. Most of MG patients need immunosuppression agents in addition to treatments that alleviate the symptoms. Intravenous immunoglobulin...

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Autores principales: Yanagihashi, Masaru, Okamoto, Ryuichi, Morioka, Harumi, Sawada, Masahiro, Matsumoto, Shingo, Ikeda, Takanori, Kano, Osamu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7453555/
https://www.ncbi.nlm.nih.gov/pubmed/32859168
http://dx.doi.org/10.1186/s12883-020-01901-2
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author Yanagihashi, Masaru
Okamoto, Ryuichi
Morioka, Harumi
Sawada, Masahiro
Matsumoto, Shingo
Ikeda, Takanori
Kano, Osamu
author_facet Yanagihashi, Masaru
Okamoto, Ryuichi
Morioka, Harumi
Sawada, Masahiro
Matsumoto, Shingo
Ikeda, Takanori
Kano, Osamu
author_sort Yanagihashi, Masaru
collection PubMed
description BACKGROUND: Myasthenia gravis (MG) is an autoimmune disease caused by antibodies that block or destroy nicotinic acetylcholine receptors at the neuromuscular junction. Most of MG patients need immunosuppression agents in addition to treatments that alleviate the symptoms. Intravenous immunoglobulin (IVIg) and plasma exchange are specific treatments given to patients with severe MG and myasthenia gravis crisis. IVIg therapy can cause an increase in serum viscosity; therefore, the risk for thromboembolic events, such as stroke, myocardial infarction, and pulmonary embolism, are reported after IVIg therapy. CASE PRESENTATION: An MG patient was treated with pyridostigmine bromide and prednisolone. The patient’s symptoms worsened 26 days after the commencement of treatment and was presented with head drop and dyspnea. The patient was diagnosed with MG crisis and IVIg was initiated. However, the patient reported chest pain and dyspnea 3 days after IVIg had started. An electrocardiogram (ECG) revealed ST elevations in leads II, III, and aVF. A cardiac catheterization was performed and stenosis, obstruction, and sclerosis were ruled out. Glyceryl trinitrate relieved the patient’s symptoms, suggesting coronary spastic angina (CSA). CONCLUSIONS: We report the first case of CSA after IVIg. Practitioners should be aware of the potential risks of CSA when administering IVIg for MG patients, in particular in old patients with vascular risk factors.
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spelling pubmed-74535552020-08-28 Coronary spastic angina after the administration of intravenous immunoglobulin in myasthenia gravis: a case report Yanagihashi, Masaru Okamoto, Ryuichi Morioka, Harumi Sawada, Masahiro Matsumoto, Shingo Ikeda, Takanori Kano, Osamu BMC Neurol Case Report BACKGROUND: Myasthenia gravis (MG) is an autoimmune disease caused by antibodies that block or destroy nicotinic acetylcholine receptors at the neuromuscular junction. Most of MG patients need immunosuppression agents in addition to treatments that alleviate the symptoms. Intravenous immunoglobulin (IVIg) and plasma exchange are specific treatments given to patients with severe MG and myasthenia gravis crisis. IVIg therapy can cause an increase in serum viscosity; therefore, the risk for thromboembolic events, such as stroke, myocardial infarction, and pulmonary embolism, are reported after IVIg therapy. CASE PRESENTATION: An MG patient was treated with pyridostigmine bromide and prednisolone. The patient’s symptoms worsened 26 days after the commencement of treatment and was presented with head drop and dyspnea. The patient was diagnosed with MG crisis and IVIg was initiated. However, the patient reported chest pain and dyspnea 3 days after IVIg had started. An electrocardiogram (ECG) revealed ST elevations in leads II, III, and aVF. A cardiac catheterization was performed and stenosis, obstruction, and sclerosis were ruled out. Glyceryl trinitrate relieved the patient’s symptoms, suggesting coronary spastic angina (CSA). CONCLUSIONS: We report the first case of CSA after IVIg. Practitioners should be aware of the potential risks of CSA when administering IVIg for MG patients, in particular in old patients with vascular risk factors. BioMed Central 2020-08-28 /pmc/articles/PMC7453555/ /pubmed/32859168 http://dx.doi.org/10.1186/s12883-020-01901-2 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Case Report
Yanagihashi, Masaru
Okamoto, Ryuichi
Morioka, Harumi
Sawada, Masahiro
Matsumoto, Shingo
Ikeda, Takanori
Kano, Osamu
Coronary spastic angina after the administration of intravenous immunoglobulin in myasthenia gravis: a case report
title Coronary spastic angina after the administration of intravenous immunoglobulin in myasthenia gravis: a case report
title_full Coronary spastic angina after the administration of intravenous immunoglobulin in myasthenia gravis: a case report
title_fullStr Coronary spastic angina after the administration of intravenous immunoglobulin in myasthenia gravis: a case report
title_full_unstemmed Coronary spastic angina after the administration of intravenous immunoglobulin in myasthenia gravis: a case report
title_short Coronary spastic angina after the administration of intravenous immunoglobulin in myasthenia gravis: a case report
title_sort coronary spastic angina after the administration of intravenous immunoglobulin in myasthenia gravis: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7453555/
https://www.ncbi.nlm.nih.gov/pubmed/32859168
http://dx.doi.org/10.1186/s12883-020-01901-2
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