A Rare case of Myasthenia Gravis in the neonate

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Newborn with a persistently open mouth. Source: Cureus
  • Myasthenia gravis in the neonate is a rare autoimmune disorder.
  • It is characterised by the transplacental transfer of maternal antibodies against the acetylcholine receptor.
  • It results in impaired neuromuscular transmission causing poor feeding and hypotonia in neonates.
  • Around 10%-15% of newborns born to women with Mysthenia Gravis.

Case presentation

This article is about a rare case of Neonatal Myasthenia Gravis. A male neonate presented to the intensive care nursery due to feeding difficulties and intermittent grunting episodes, which started 2 hours after birth due to poor sucking. However, he was breastfeeding normally before that. The mother had an uneventful pregnancy with no alarming symptoms. In addition, the delivery of the baby through elective C-section was also uneventful.

Findings revealed Myasthenia Gravis

The doctors performed his initial laboratory investigations which were normal. However, his creatinine kinase and anti-acetylcholine receptor antibody were elevated. Moreover, his physical examination revealed a weak cry due to weak facial expressions, inability to fully close his eyes, and his mouth was constantly open with swallowing difficulties. In addition, he assumed a frog-leg position and showed generalized hypotonia. He had no respiratory distress and his neonatal reflexes, for example, the Moro reflex and Grasp reflex were present. Based on all of these findings, the doctors diagnosed him with transient neonatal myasthenia gravis.

Treatment

The doctors treated him with an anticholinesterase agent but it had very slow progress. Therefore, the doctors administered intravenous immunoglobulin on the eighth and ninth days, which resulted in significant clinical improvement. However, the doctors noticed a cholinergic crisis on the fourteenth day, so they gradually reduced the anticholinesterase agents until suspension on the thirty-first day. The neonate completely recovered and was asymptomatic during his first month.

Reference: Cureus

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