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All Journal JURNAL GIZI INDONESIA Jurnal Kedokteran Diponegoro Journal of Biomedicine and Translational Research Jurnal Berkala Epidemiologi Global Medical and Health Communication The Indonesian Biomedical Journal Jurnal Epidemiologi Kesehatan Komunitas Bioscientia Medicina : Journal of Biomedicine and Translational Research Medica Hospitalia Jurnal Ilmiah Permas: Jurnal Ilmiah STIKES Kendal Bioscientia Medicina : Journal of Biomedicine and Translational Research
K. Heri Nugroho HS, K. Heri
Department Of Internal Medicine, Faculty Of Medicine, Universitas Diponegoro/RSUP Dr. Kariadi, Semarang
Biochemistry, Genetics & Molecular Biology Dentistry Education Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health Veterinary

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Oropharyngeal Dysphagia as The Presenting Symptom of Myasthenia Gravis with Diabetes Mellitus Kurnia, Handy; Seno, Heri Nugroho Hario; Bintoro, Aris Catur; Purnomo, Hery Djagat
Medica Hospitalia : Journal of Clinical Medicine Vol. 11 No. 3 (2024): Med Hosp
Publisher : RSUP Dr. Kariadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36408/mhjcm.v11i3.1154

Abstract

Background: Oropharyngeal dysphagia may caused by a variety of causes. Myasthenia gravis is a common autoimmune disease affecting the neuromuscular junction. While ocular symptoms are common in myasthenia gravis, bulbar symptoms such as dysarthria and dysphagia are less common. Aim: To present the importance of recognizing atypical presentations of myasthenia gravis and utilizing electromyography in diagnosis when AChR antibody testing is unavailable. Case Presentation: A 57-year-old woman was referred because of progressive dysphagia for both solid and liquid food. She also experienced weight loss, heaviness of the right eyelid, drooling, and chewing difficulty. Medical history revealed diabetes. Vital signs were stable. Physical examination revealed right ptosis without any other neurological deficits. Wartenberg test and dysarthria counting test were positive. Laboratory examination revealed a blood glucose level of 270 mg/dL and an HbA1c level of 9.4%. The barium swallow study revealedno abnormalities. Esophagogastroduodenoscopy revealed esophageal candidiasis. Electromyography showed more than 20% decremental response of the orbicularis oculi muscle. This result is suggestive of neuromuscular junction disorder. Improvement of the condition was achieved after the administration of intravenous steroids and oral pyridostigmine combined with therapeutic plasma exchange. Discussion: Oropharyngeal dysphagia accompanied by ptosis and positive Wartenberg & dysarthria counting test is suggestive of myasthenia gravis. Although an AChR antibody test cannot be performed, significant electromyography alongside relevant clinical presentation is sufficient to diagnose myasthenia gravis. Conclusion: It is crucial to recognize the accompanying signs and symptoms of oropharyngeal dysphagia. EMG may be used to diagnose MG in the appropriate clinical context.
Co-Authors Abdul Mughni Agus Layanto Anindita, Yohana Prima Ceria Antono Suryoputro Antono Suryosaputro Ariawan Soejoenoes Aris Catur Bintoro Arthur Lelono Arum Kartikadewi Awal Prasetyo Ayudyah Nurani Bagoes Widjanarko Charles Limantoro Diana Diana Diana Nur Afifah, Diana Nur Djoko Trihadi Lukmono Djoko Trihadi Lukmono Dwi Lestari Partiningrum Fathur Nur Kholis Fransisca Yustika Dewi Siahaan Friska Anggraini Helena Silitonga Gracilaria Puspa Sari Handy Kurnia Hanifah Ardiani Hanifah Ardiani Henry Setyawan Susanto Henry Setyawan Susanto Hery Djagat Purnomo Hery Djagat Purnomo Ika Vemilia Warlisti Indra Kusuma Adi Putranto Kartika Widyakusuma Agung Putri Kusmiyati Tjahjono Kusmiyati Tjahjono Lestariningsih Lestariningsih Lisyani Budipradigdo Marisa Gita Putri Marisa Gita Putri Mateus Sakundarno Mateus Sakundarno Adi, Mateus Sakundarno Minuljo, Tania Tedjo Muchlis Achsan Udji Sofro Nyoman Suci Widyastiti Pusaka, Semerdanta Rakhma Yanti Hellmi Rakhma Yanti Hellmi Ratnasari Dwi Cahyanti Resna Meiwarnis Rina Rina Roesipin, Sri Wahyuningsih Selamat Budijitno Shofa Chasani Shofia Aji Hidayatillah Silitonga, Marisi Elizabeth R. Soeharyo Hadisaputro Sofyan Rais Addin Sri Wahyuningsih Sri Wahyuningsih Roesipin Suhartono Suhartono Suhartono, Suhartono Suharyo Hadisaputro Suharyo Hadisaputro Suharyo Hadisaputro Sulistio Rini Tjokorda Gde Dalem Pemayun Tjokorda Gde Dalem Pemayun Tjokorda Gde Dalem Pemayun