Severe Case of Generalized Myasthenia Gravis Presenting with Myasthenic Crisis: A Case Report

Myasthenia gravis (MG) is an autoimmune disorder of the neuromuscular junction that may present atypically in elderly patients and can be easily overlooked in the intensive care setting. This case report describes a 73-year-old patient with multiple comorbidities who presented with convulsions, altered sensorium, and severe hypoxemic respiratory failure requiring emergency intubation and mechanical ventilation. The initial clinical picture suggested a primary neurological or cerebrovascular event; however, persistent ventilator dependence and unexplained respiratory weakness prompted further neurological evaluation. On the third day of intensive care unit admission, a neurology consultation raised suspicion of an underlying neuromuscular junction disorder, and serum anti–acetylcholine receptor antibodies were advised to rule out myasthenia gravis. This report highlights the diagnostic challenges of myasthenia gravis in critically ill elderly patients, particularly when masked by comorbid neurological conditions. A clinically oriented discussion emphasizes the importance of considering myasthenia gravis in cases of unexplained respiratory failure, timely neurological consultation, and early initiation of appropriate diagnostic testing to improve outcomes.