A case of refractory myasthenia gravis in the elderly demonstrating remission following rituximab therapy

Abstract

Myasthenia gravis (MG) is an autoimmune disorder characterized by antibodies against acetylcholine receptors at the neuromuscular junction, leading to various symptoms such as muscle weakness, fatigue, and ptosis. While MG traditionally affects young women in their 30s, recent trends indicate an increasing incidence in the elderly population regardless of gender. Diagnosis and management of MG in the elderly pose challenges due to diverse presentations and higher risks of complications from standard treatments. Rituximab, an immunosuppressive agent, has shown efficacy in refractory MG cases, offering a promising therapeutic option. Here, we present a case of an 82-year-old female with Alzheimer dementia who presented with generalized weakness, ultimately diagnosed with MG. Despite initial treatment with immunoglobulin and subsequent relapse, rituximab therapy led to significant improvement in symptoms and functional status. Our case underscores the diagnostic challenges and therapeutic complexities of MG in the elderly and highlights rituximab as a valuable treatment option.