Case Report: Early rehabilitation initiated in the intensive care unit for myasthenic crisis.

Myasthenia gravis is an autoimmune disorder of the neuromuscular junction characterized by fatigable muscle weakness. Myasthenic crisis is a life-threatening condition characterized by acute respiratory failure resulting from severe weakness of the respiratory muscles. Currently, no established guidelines exist for physiological assessment at the time of mobilization, or for the content and intensity of exercise therapy, in patients with severe myasthenia gravis presenting with myasthenic crisis. We report a case of newly diagnosed myasthenia gravis with myasthenic crisis wherein exercise therapy was initiated in the intensive care unit, with careful monitoring of vital signs and muscle fatigability, ultimately leading to discharge. A 67-year-old woman presented with a dropped head, gait disturbance, and respiratory failure, and was diagnosed with myasthenia gravis at our hospital. On the same day, the patient developed hypoxemia, underwent endotracheal intubation, and was admitted to the intensive care unit for mechanical ventilation. Exercise therapy was initiated on hospital day 3, and the exercise workload progressively increased while vital signs and fatigability were monitored. Standing training began on day 12; and ambulation training while receiving mechanical ventilation was introduced on day 17 without adverse events. The patient was successfully weaned off mechanical ventilation on day 24, and exercise therapy was continued thereafter. Physical function improved after steroid pulse therapy and a thymectomy; she achieved independent ambulation with a cane on day 64 and was discharged on day 78. Early exercise therapy guided by monitoring and muscle fatigue assessments may facilitate functional recovery without clinical deterioration. However, larger studies are required to evaluate its safety and efficacy.