Multiple concurrent opportunistic infections in patient with myasthenia gravis: A case report

Myasthenia gravis (MG), a rare autoimmune disorder with poor prognosis, especially when complicated by opportunistic infections, which pose significant risks in clinical practice. We aimed to analyse a clinical case of a middle-aged male patient with MG, who developed severe lower gastrointestinal bleeding and multiple opportunistic infections post-immunosuppressive therapy. This case report is based on comprehensive clinical evaluations, including colonoscopy, histopathological examination, bronchoscopy, bronchoalveolar lavage (BAL), and metagenomic next-generation sequencing (mNGS). The patient exhibited persistent ptosis and pulmonary infection, and was treated with Meropenem 12 mg once daily (qd), Tacrolimus 2 mg qd, and Bromhexine 60 mg three times daily (tid). Due to ongoing lower gastrointestinal bleeding, surgery was performed. Colonoscopy revealed multiple ulcers, with histopathology confirming Cytomegalovirus (CMV) and Histoplasmosis infections. Bronchoalveolar lavage fluid (BALF) identified infections with Aspergillus fumigatus, Talaromyces, and Stenotrophomonas maltophilia. mNGS further detected Pneumocystis jirovecii. Based on these findings, the treatment plan was adjusted to include Amphotericin B complex 25 mg via intravenous (IV) qd, Tigecycline 100 mg q12h, and Sulfamethoxazole (SMZ) 0.96 g q6h for anti-infection, along with Ganciclovir 250 mg IV q12h. The patient continues to receive infusions of immunoglobulins and albumin. This case underscores the importance of monitoring MG patients on immunosuppressive therapy for opportunistic infections, emphasizing the complexity of managing multiple pathogens simultaneously.