Managing myasthenic crisis after video-assisted thoracoscopic thymectomy with therapeutic plasma exchange

Myasthenia gravis (MG) is a chronic autoimmune neuromuscular disorder marked by fluctuating skeletal muscle weakness, with thymectomy being a key therapeutic option particularly in thymoma-associated cases. We report a 24-year-old female patient with early-onset MG who underwent video-assisted thoracoscopic thymectomy (VATS). Despite adequate preoperative stabilization with therapeutic plasma exchange (TPE), she developed a postoperative myasthenic crisis requiring intensive care and ventilatory support. Early recognition of clinical deterioration and prompt initiation of additional TPE sessions facilitated rapid neurological recovery and avoided prolonged mechanical ventilation. This case highlights the dual role of TPE as both a preoperative immunomodulatory strategy and a rescue therapy during postoperative crisis. It underscores the importance of individualized perioperative planning, cautious selection of medications-particularly antibiotics that may exacerbate MG-and close multidisciplinary collaboration. Timely intervention with TPE can significantly improve outcomes in high-risk MG patients undergoing thymectomy.