Cough-Variant Asthma in a Myasthenia Gravis Patient on Treatment With Steroids and Rituximab

Muscle weakness that worsens on exercise and improves on resting is the hallmark of myasthenia gravis (MG), an uncommon autoimmune illness. Acetylcholinesterase inhibitors, immunosuppressants, and corticosteroids are commonly used in treatment. Rituximab has been tried in refractory patients. On the contrary, asthma is characterized by a persistent inflammation of the airways and a range of symptoms, including cough-variant asthma (CVA), in which the main symptom is only cough. We describe the case of a female in her 30s who had a history of MG and had been treated with steroids and rituximab. The patient had an acute dry cough in bouts. Spirometry revealed no obstructive or restrictive pattern, and the chest X-ray was normal. Based on allergy diathesis, a diagnosis of CVA was hypothesized and confirmed clinically by the patient's reaction to long-acting beta-agonists and inhaled corticosteroids. This case emphasizes how difficult it can be to diagnose respiratory symptoms in MG patients and how crucial it is to rule out CVA as a differential diagnosis, particularly in patients who have recently started immunomodulatory medication and have an allergy tendency. Fast symptom relief and positive clinical results were achieved by the efficient use of inhalation treatment.