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Kidney Week

Abstract: SA-PO612

A Rare Case of Ocular Myasthenia Gravis in a Patient with ESRD

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Giesing, William, Methodist Dallas Medical Center, Dallas, Texas, United States
  • Santiago-Gonzalez, Hector L., Methodist Dallas Medical Center, Dallas, Texas, United States
  • Collazo-Maldonado, Roberto L., Methodist Dallas Medical Center, Dallas, Texas, United States
Introduction

Myasthenia gravis (MG) is a rare autoimmune disorder caused by defective neurotransmitter transmission at the neuromuscular junction. The overall prevalence is about 150 to 200 cases per million. MG typically presents with fluctuating weakness and fatigability of ocular, bulbar, limb, and/or respiratory muscles. Very rarely, patients may present with isolated ocular symptoms, also known as ocular MG.

Case Description

An 82-year-old Hispanic woman with a past medical history of type II diabetes mellitus, hypertension, and end-stage renal disease (ESRD) on hemodialysis (HD) presented with sudden-onset ptosis of the right eyelid. Her vital signs were stable, and the rest of her physical exam was unremarkable. She underwent a computed tomography (CT) scan of the head and magnetic resonance imaging of the brain, both of which were unremarkable. A thyroid function test was normal and a CT of the chest looking for a thymoma was negative. Neurology was consulted and there was a high clinical suspicion for ocular MG. An ice pack test was performed and demonstrated improvement of her ptosis. She was started on pyridostigmine with improvement of her symptoms. Muscle-specific kinase and acetylcholine-binding antibody assays were negative, which is not uncommon in patients with ocular MG.

Discussion

Ocular MG is an extremely rare disease. In patients with ESRD on hemodialysis, it is an even rarer phenomenon. In addition, patients on HD are known to be at increased risk for stroke, a diagnosis often included in a list of differentials considered when assessing patients with physical manifestations of MG. It remains paramount to rule out acute stroke in patients with ESRD on HD presenting with motor deficits. However, it is also important to consider rarer etiologies, such as ocular MG, in the list of differential diagnoses.