A case of takotsubo cardiomyopathy leading to the diagnosis of myasthenia gravis

Abstract

A 52-year-old woman presenting with shortness of breath and having no related past medical history was diagnosed with takotsubo cardiomyopathy. However, she revealed respiratory failure atypical with takotsubo cardiomyopathy. We diagnosed myasthenia gravis with myasthenic crisis by acetylcholine receptor-binding antibody titer with mediastinal tumor. Physical or emotional stress is well known to trigger the onset of takotsubo cardiomyopathy. Similarly, myasthenia crisis is also triggered by stress. Here, we report a case of simultaneous occurrence of takotsubo cardiomyopathy and myasthenia crisis.

Keywords: Myasthenia gravis; Takotsubo cardiomyopathy.

Fig. 1

12-Lead electrocardiograms at admission (A) and 4 months from onset (B). 12-Lead electrocardiogram at admission demonstrated ST elevation in leads I, II, aVL, V2, V5, V6, and reciprocating ST depression in leads III, aVR, and V1 (A). At 4 months from onset, the electrocardiogram showed a completely normal pattern (B).

Fig. 2

Left ventriculogram demonstrated left ventricular apical ballooning on end systolic frame.

Fig. 3

Thorax contrast enhanced computed tomography (CT) scan. CT scan of the thorax revealed the presence of a round mass at the level of the anterior mediastinum (*) and it invaded the superior vena cava.

Fig. 4

Electromyogram with repetitive nerve stimulation at a frequency of 3 Hz showed 12% decremental response of the median nerve compound muscle action potential amplitude.

Fig. 5

Microscopic appearance of the thymoma [hematoxylin and eosin stain, 40× (A), cytokeratin stain, 40× (B)]. Microscopic appearance of the thymoma, which was a type B1 thymoma, showing ovoid spindle shaped cells with mature lymphocytes.