A 35 year old woman presents to the Emergency Department with 1 day history of fever, urinary frequency and left loin pain. She has a urine dip positive for leucocytes, nitrites, protein and blood and raised inflammatory markers. She is diagnosed with pyelonephritis and started on IV amoxicillin and gentamicin. 24 hours later she reports diplopia, dysphagia and breathlessness. On further questioning she describes a 2 month history of diplopia towards the end of the day which she put down to needing new glasses and too much screen time.
On examination she a fatigable muscle weakness, diplopia and tachypnea with use of accessory muscles of respiration.
She is diagnosed with possible myasthenic crisis.
