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Case Report
A case of anti-muscle specific kinase myasthenia gravis in pregnancy with neuromuscular respiratory failure mimicking preeclampsia
1 Resident Physician, Department of Obstetrics and Gynecology, NYU Langone Hospital-Long Island, NYU Grossman Long Island School of Medicine, Mineola, NY, USA
2 Fellow, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, NYU Langone Hospital, NYU Grossman School of Medicine, New York, NY, USA
3 Assistant Professor, NYU Grossman Long Island School of Medicine, Mineola, NY, USA
4 Assistant Professor, NYU Grossman Long Island School of Medicine; Residency Program Director, Obstetrics and Gynecology, NYU Langone Hospital-Long Island, Mineola, NY, USA
5 Professor, Department of Obstetrics and Gynecology at NYU Grossman Long Island School of Medicine; Chief, Obstetrics—NYU Langone Long Island Hospital, Mineola, NY, USA
6 Chief Patient Safety Officer of Obstetrics, Northwell Health-Western Region; Professor of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
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Erin L Miller
MD, MPH, Department of Obstetrics and Gynecology, NYU Langone Hospital— Long Island, NYU Langone Health, 259 First Street, Mineola, NY 11501,
USA
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Article ID: 100191Z08EM2025
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How to cite this article
Miller EL, Nawlo J, Rekawek P, Vahanian SA, Sicuranza G, Vintzileos AM. A case of anti-muscle specific kinase myasthenia gravis in pregnancy with neuromuscular respiratory failure mimicking preeclampsia. J Case Rep Images Obstet Gynecol 2025;11(1):6–10.ABSTRACT
Introduction: This report discusses a rare case of antimuscle specific kinase (MuSK) positive myasthenia gravis (MG) during pregnancy, presenting with respiratory failure mimicking preeclampsia with severe features.
Case Report: A 29-year-old primigravida presented to triage at 36 weeks with symptoms of dyspnea, orthopnea, and tachypnea necessitating cesarean delivery. Postpartum she developed neuromuscular respiratory failure leading to multiple re-intubations. Multi-system testing ultimately revealed anti-muscle specific kinase (anti-MuSK) positive serotype.
Conclusion: Despite the challenges in diagnosis and management, interdisciplinary collaboration and long-term follow-up were emphasized. Teaching points highlight the need to consider autoimmune disorders in peripartum cardiopulmonary exacerbations. The case prompts further investigation into the physiologic implications of concurrent new-onset myasthenia gravis and preeclampsia.
Keywords: Autoimmune, High risk pregnancy, Neuromuscular junction disorders, Preeclampsia
SUPPORTING INFORMATION
Author Contributions
Erin L Miller - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
J Nawlo - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
P Rekawek - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
SA Vahanian - Acquisition of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
G Sicuranza - Acquisition of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
AM Vintzileos - Analysis of data, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2025 Erin L Miller et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
