Introduction: Myasthenia gravis is a disease of the neuromuscular junctions in which antibodies target the acetylcholine receptors of the postsynaptic membranes, causing skeletal muscle weakness and fatigability. Myasthenic crisis is an acute exacerbation of these symptoms that requires non-invasive ventilatory support or intubation. Only a few case reports exist of such episodes following administration of radiographic contrast for computed tomography.

Case Report: A patient with poorly-controlled symptoms of myasthenia gravis was administered intravenous contrast during computed tomography (CT) pulmonary angiogram. Following contrast injection, the patient became nauseated and acutely hypoxic, followed by respiratory arrest and intubation. Clinical examination and nerve conduction studies were subsequently consistent with myasthenic crisis, which resolved completely with treatment.

Conclusion: Our review of existing literature of contrast-precipitated myasthenic crisis finds no conclusive link between contrast type and severity of reaction, but is limited by inconsistencies in reporting. Further examination is required to determine the risk to patients with myasthenia gravis from contrast exposure.

Keywords: Computed tomography, Myasthenia gravis, Myasthenic crisis