MYASTHENIA-GRAVIS AND STEROID-INDUCED MYOPATHY OF THE RESPIRATORY MUSCLES

Objective: We report a case of corticosteroid-induced myopathy with involvement of respiratory muscles observed in a myasthenic patient. Patient: A 37-years-old woman, under corticosteroid treatment for two years for typical myasthenia gravis was admitted to ICU for acute myasthenic respiratory failure. Weaning from mechanical ventilation remained impossible despite 4 plasma exchanges and azathioprin. The patient exhibited a progressive 12 kg weight loss with muscular weakness and atrophy. Measurements and results: Peripheral and diaphragmatic electromyography as well as histological study were consistent with a steroid-induced myopathy. Discontinuation of corticosteroid treatment was followed by a rapid weight gain with general improvement and allowed weaning from mechanical ventilation with a complete recovery. Conclusion: This case provides evidence that corticosteroid-induced myopathy may be observed in myasthenia gravis and may involve the respiratory muscles as well as the peripheral musculature.