A 44-year-old woman comes to the physician because of diplopia and progressive weakness for the past month. She has noticed increasing difficulty performing household chores and walking her dog. Sometimes, she feels too fatigued to cook dinner. receiving low-dose pyridostigmine for treatment of her condition and claims good compliance without significant side effects. Physical examination reveals fatigable asymmetric ptosis and binocular horizontal diplopia. Infusion of edrophonium elicits a significant improvement in her symptoms. Which of the following is the best next step in management of this patient?

Question

A 44-year-old woman comes to the physician because of diplopia and progressive weakness for the past month. She has noticed increasing difficulty performing household chores and walking her dog. Sometimes, she feels too fatigued to cook dinner. receiving low-dose pyridostigmine for treatment of her condition and claims good compliance without significant side effects.  Physical examination reveals fatigable asymmetric ptosis and binocular horizontal diplopia.  Infusion of edrophonium elicits a significant improvement in her symptoms.  Which of the following is the best next step in management of this patient?

Quizplus · Accepted Answer

Eductional Objective: Exacerbation of myasthenia gravis in a patient treated with long-acting acetylcholinesterase inhibitors (eg, pyridostigmine) occurs due to myasthenic or cholinergic crisis. The edrophonium (Tensilon) test helps to differentiate these 2 conditions. Clinical improvement after edrophonium administration indicates that the patient is undertreated (myasthenic crisis).

A 44-Year-Old Woman Comes to the Physician Because of Diplopia