A 58-year-old female presented with a 1-month history of bulbar symptoms in the form of difficulty in swallowing and speaking. Anti-MuSK antibodies were positive. CECT of the chest was normal. She was treated with five cycles of plasma exchange followed by IVIG. She had persistent bulbar weakness after 1 month of the above treatment, so she was administered IV rituximab. She improved remarkably, with almost complete resolution of her bulbar and other symptoms. She is doing well at 8-month follow-up.
A 49-year-old lady with MuSK-positive MG, diagnosed outside and treated with steroids, presented with fever, cough, and breathlessness for 2 weeks. Keeping a possibility of community-acquired pneumonia, she was managed with IV antibiotics with which her fever improved, but her dyspnea continued. Myasthenia crisis was considered, and a cycle of IVIG (2 g/kg) followed by IV cyclophosphamide was given with mild improvement. She was continuing monthly IV cyclophosphamide but never attained remission. She was then started on IV rituximab (375 mg/m2 weekly for 4 weeks), to which she responded remarkably with complete resolution of respiratory difficulty and other symptoms.