antibodies form against acetylcholine nicotinic postsynaptic receptors at the neuromuscular junction of skeletal muscles is sometimes identified as having an ocular and generalized form, although one is not exclusive of the other and the ocular form is considered an initial, milder form of illness that progresses to the more severe generalized form in most but not all patients. Si ho, a 21 year-old gymnastic student, presents with complaints of muscle weakness in her face that comes and goes, but has been getting worse over the past two months. Most notably, she complains that her jaw gets tired as she chews and that swallowing has become difficult. She also notes diplopia (double vision) which seems to come on late in the evening, particularly after reading for a few minutes. At work, it has become increasingly difficult to spot her gymnasts during acrobatic moves because of upper arm weakness. OTHER SYMPTOMS: Shortness of breath Neck and upper spine pain Chest pain and difficulty breathing Could not move her head up for more than few minutes at a time Symptoms worsen with fatigue HEMATOLOGY COMPLETE BLOOD COUNT REFERENCE RANGE RESULTS REMARK S RED BLOOD CELLS 4.2-5.4 million cells/ul 5.0 million NORMAL cells/ul WHITE BLOOD CELLS 4,500-10,000/ul 8,800 cells /ul NORMAL PLATELETS 150,000-450,000/ul 300, 000/ul NORMAL HEMOGLOBIN 12-15 g/dl 14g/dl NORMAL HEMATOCRIT 36-48% 45% NORMAL TEST RESULT ANTI-ACETYLCHOLINE RECEPTOR POSITIVE ANTIBODIES BIOPSY RESULT (thymus)
Thymus is enlarged. Lymphoid hyperplasia of the thymus ,increased number of
lymphoid follicles. The tumor ranged in size from 7x2.5x3 cm. After having a positive result for ACETYCHOLINE RECEPTOR ANTIBODY TEST, Si Ho was diagnosed with Myasthenia Gravis. CT Scan of her chest revealed a mediastinal mass. Thus, thymectomy was performed. Histopathology result revealed a benign tumor.