Assuntos
Encéfalo , Síndrome Inflamatória da Reconstituição Imune , Leucoencefalopatia Multifocal Progressiva , Natalizumab , Humanos , Natalizumab/efeitos adversos , Síndrome Inflamatória da Reconstituição Imune/induzido quimicamente , Leucoencefalopatia Multifocal Progressiva/diagnóstico por imagem , Leucoencefalopatia Multifocal Progressiva/induzido quimicamente , Encéfalo/diagnóstico por imagem , Fatores Imunológicos/efeitos adversos , Imageamento por Ressonância Magnética , Masculino , Esclerose Múltipla Recidivante-Remitente/tratamento farmacológico , Feminino , Adulto , Pessoa de Meia-IdadeRESUMO
An 86-year-old woman was admitted to our hospital with cryptogenic progressive dyspnea and dysphagia following a tracheostomy procedure 4 months prior to presentation. She exhibited fluctuating diplopia, bilateral vocal fold paralysis, normal nerve test results, negative findings for serum anti-acetylcholine receptor and anti-muscle-specific kinase antibodies, and positive findings for anti-LDL-receptor related protein 4 (LRP4). A videofluoroscopic swallowing study (VFSS) with edrophonium revealed an improvement in bulbar paralysis. Consequently, the patient was diagnosed with double-seronegative myasthenia gravis (DSN-MG) and began immunomodulatory therapy. This case emphasizes the diagnostic challenges of bulbar-type DSN-MG and underscores the value of a VFSS with edrophonium for diagnosing this condition.