Multiple concurrent opportunistic infections in patient with myasthenia gravis: A case report

Area of Science:

• Clinical Medicine
• Immunology
• Infectious Diseases

Background:

• Myasthenia gravis (MG) is a rare autoimmune disorder with a guarded prognosis, particularly when complicated by opportunistic infections.
• Immunosuppressive therapy in MG patients increases the risk of severe and multiple infections, posing significant clinical challenges.

Purpose of the Study:

• To analyze a clinical case of a middle-aged male patient with MG who developed severe lower gastrointestinal bleeding and multiple opportunistic infections post-immunosuppressive therapy.
• To highlight the diagnostic and therapeutic complexities in managing co-existing infections in MG patients.

Main Methods:

• Comprehensive clinical evaluations including colonoscopy, histopathology, bronchoscopy, bronchoalveolar lavage (BAL), and metagenomic next-generation sequencing (mNGS).
• Histopathological examination confirmed Cytomegalovirus (CMV) and Histoplasmosis.
• BAL fluid and mNGS identified infections with Aspergillus fumigatus, Talaromyces, Stenotrophomonas maltophilia, and Pneumocystis jirovecii.

Main Results:

• The patient presented with persistent ptosis, pulmonary infection, and severe lower gastrointestinal bleeding.
• Multiple pathogens including CMV, Histoplasmosis, Aspergillus, Talaromyces, S. maltophilia, and P. jirovecii were identified.
• Treatment required adjustment to broad-spectrum anti-infectives and supportive care, including immunoglobulins and albumin.

Conclusions:

• MG patients on immunosuppressive therapy require vigilant monitoring for opportunistic infections.
• Simultaneous management of multiple pathogens in MG is complex and necessitates a multi-faceted approach.
• Prompt and accurate diagnosis using advanced techniques like mNGS is vital for effective treatment strategies.