Abstract

Background: Myasthenic crisis is a life-threatening neurological emergency characterized by respiratory failure due to neuromuscular weakness. Diagnosis may be delayed in elderly patients with overlapping cardiopulmonary comorbidities. Case Summary: A 73-year-old male with hypertension, diabetes mellitus, and recently diagnosed bronchial asthma presented with progressive dyspnea. Despite relatively stable vital signs, clinical examination revealed bulbar dysfunction and neck flexor weakness. Arterial blood gas analysis demonstrated hypercapnic respiratory failure. Electrophysiological studies and serology confirmed previously undiagnosed myasthenia gravis presenting as myasthenic crisis. The patient required invasive mechanical ventilation and was treated with intravenous immunoglobulin, acetyl-cholinesterase inhibitors, and corticosteroids, resulting in full clinical recovery. Conclusion: This case highlights the importance of early recognition of myasthenic crisis in elderly patients presenting with respiratory failure and emphasizes the value of careful neurological examination in the emergency setting.

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