Diplopia in a patient presenting with “blurred vision”: a case report

Journal of Medical Case Reports

Case Report

Anil Harrison¹  Mayank Rampal¹  Jun Yoo¹  Onkar Mudhar² 

[1] Department of Internal Medicine, UCF/HCA, Pensacola, FL, USA;Internal Medicine Resident, Department of Internal Medicine, Touro University, Stockton, CA, USA;

关键词: Blurred vision;    Binocular diplopia;    Ocular myasthenia gravis;    Neuromuscular junction;   

DOI  :  10.1186/s13256-023-04089-4

 received in 2023-05-30, accepted in 2023-07-18,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundMyasthenia gravis is an autoimmune condition affecting the neuromuscular junction and causing muscle weakness along with fatigue (myasthenia). When the clinical manifestations of myasthenia gravis are isolated to the eye muscles, only causing weak eye movements, it is referred to as ocular myasthenia gravis, which can mimic a 1 and ½ syndrome.Case presentationAn African-American female in her fifties with past medical history of hypertension presented to our outpatient clinic with complaints of blurred vision for two weeks. Her symptoms were associated with facial discomfort and a generalized headache. On physical examination upon her initial presentation, there was demonstratable swelling of the left upper eyelid with drooping. Her extraocular movements revealed defects with the abduction and adduction of the right eye, and the left eye would not adduct, although the outward movement was normal. The left eye failed to lift/elevate completely when looking upwards, a pseudo 1 and ½ syndrome. A positive Cogan lid twitch was also noticed. Imaging of the brain and orbit ruled out central causes. Diagnosis of ocular myasthenia gravis was made in accordance with positive anti-acetylcholine receptor antibodies. With 120 mg pyridostigmine oral dose, the patient experienced improvement subjectively and objectively, and the patient was discharged on oral pyridostigmine and prednisone. Six months later, with prednisone having been tapered off, the patient developed a myasthenic crisis and was treated with plasmapheresis and intravenous immunoglobulins. After recovering from the myasthenic crisis, efgartigimod infusions were instituted, which helped our patient restore normal life.ConclusionOur patient who presented with “blurred vision” was discovered to have binocular diplopia due to significant dysconjugate eye movements. After diligently ruling out central etiologies, we concluded that her presentation was due to a peripheral etiology. Her serologies and her presentation helped confirm a diagnosis of ocular myasthenia gravis. Also, as in most cases, our patient also progressed to develop generalized myasthenia gravis while on pyridostigmine. Efgartigimod infusions instituted after our patient recovered from a myasthenic crisis have helped her restore a normal life.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023