Beyond Respiratory Failure: Unmasking Myasthenic Crisis in the Emergency Department

Myasthenic crisis is a life-threatening complication of myasthenia gravis (MG), typically presenting in patients with a known diagnosis.However, the absence of collateral history can delay recognition when respiratory failure is the initial manifestation.We report a 34-year-old male patient who presented to the emergency department with acute respiratory failure.Initial evaluation suggested airway compromise, but standard pulmonary, cardiac, and airway investigations were unrevealing.During hospitalization, he developed progressive bulbar and limb weakness, and a collateral history later revealed a prior diagnosis of MG treated with pyridostigmine.He required multiple intubations due to fluctuating muscle weakness and repeated extubation failures.The patient was treated with serial plasma exchange and corticosteroids, eventually stabilizing with a tracheostomy for prolonged ventilatory support.This case highlights the diagnostic challenges of myasthenic crisis when collateral history is unavailable.Repeated extubation failures underscore the importance of careful assessment of bulbar and respiratory muscle function.Early, targeted interventions such as plasma exchange and corticosteroids are crucial to improving outcomes.Acute respiratory failure may be the initial presentation of myasthenic crisis.Prompt recognition, vigilant airway management, and early disease-specific therapy are essential for optimal patient outcomes.