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Myasthenic Crisis — RACP Adult Medicine MCQ

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ModerateNeurologyMyasthenic CrisisRACP Adult Medicine

A 55-year-old man with myasthenia gravis (anti-AChR antibody positive) is being treated with pyridostigmine. His symptoms worsen and he develops a myasthenic crisis with respiratory failure requiring intubation. What is the recommended treatment for myasthenic crisis?

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Correct answer: D — IV immunoglobulin or plasma exchange

Myasthenic crisis (respiratory failure due to severe myasthenic weakness) is treated with either IVIg (0.4 g/kg/day for 5 days) or plasma exchange (5 exchanges over 10–14 days). Both have similar efficacy. Anticholinesterase medications should be temporarily withheld during crisis (risk of cholinergic crisis confounding the picture and excessive secretions). Corticosteroids may worsen weakness initially (transient steroid-induced exacerbation) and should be introduced cautiously after the acute crisis resolves.

Reference: eTG – 2025 – Neurology; AAN – 2021 – Myasthenia Gravis Guidelines