Therapeutic Plasma Exchange in the Management of Myasthenia Crisis in a Resource Poor Setting

BACKGROUND: Therapeutic Plasma Exchange (TPE) is an apheresis treatment in which the plasma component of blood is removed and replaced with supplemental fluids. It is an immunomodulatory treatment that has been reported to be a successful therapeutic procedure for the treatment of severely compromised patients with myasthenia gravis when given at short intervals. TPE is known to have a comparable efficacy to intravenous immunoglobulin (IVIG) in the treatments of patients with moderate to severe myasthenia crisis. METHODOLOGY: We report a case of a 47year old male patient with severe myasthenia crisis. He was managed using cobe spectra version 6.1 to carry out an automated TPE, with a suboptimal response and subsequent use of IVIG resulting in full recovery. This report highlights the possible factors that may hinder optimal response of a patient with Myasthenia crisis to TPE procedure in a poor resource setting. CONCLUSION: TPE is an essential immunomodulatory therapy in the management of acute myasthenia crisis whether given alone or in combination with immunosuppressive drugs. There can be a rebound overproduction of the offending autoantibodies in MG following TPE which can be cleared from circulation using immunosuppressive therapy.